A Rare Cause Of Acute Abdomen: Thrombosis In Ileocolıc Branch of Superior Mesenteric Vein

Abstract

M esenteric vein thrombosis (MVT) is a rare cause of acute abdomen. It is evaluated as a primary MVT whose etiology cannot be determined and secondary MVT caused by a predisposing factor. Predisposing factors include infection which leads to hypercoagulability; abdominal surgery; deficiency of protein C, protein S, and antithrombin III; factor V Leiden mutation; presence of lupus anticoagulant; antiphospholipid syndrome; and malignancy. The disease commences with non-specific progressive abdominal pain and it might worsen with advancement of ischemia along with nausea, vomiting, and bloody diarrhea and finally, it might lead to sepsis. MVT has high mortality rates if left untreated. This study discusses a case in which the patient presented to the emergency department with complaints of abdominal pain and fever, computed tomography (CT) revealed thrombosis in the ileocolic branch of the superior mesenteric vein, and the complaints completely improved after LMWH treatment. Case ReportAn 80-year-old man presented to the emergency department complaining of progressive, worsening abdominal pain for 3 days and fever, which began on that morning. His vital signs were as follows: blood pressure, 110/65 mm Hg; heart rate, 110/min; and body temperature, 38.8°C. His physical examination revealed tenderness in right lower quadrant of the abdomen with palpation and no guarding or rebound tenderness. According to laboratory studies, his WBC was 13700/mm 3 ; CRP levels were 17 mg/dl; and kidney function, liver enzymes tests, and blood electrolytes were evaluated to be normal. There was no significant finding on erect AXR and abdominal ultrasonography. Therefore, contrast-enhanced abdominal CT was required, and a thrombus in the ileocolic branch of the superior mesenteric vein and inflammation in the surrounding fatty mesenteric tissue were observed (Fig. 1). There were no supSuperior mesenteric vein thrombosis is a rare cause of acute abdomen. Patients usually complain of non-specific abdominal pain, which may show progress with secondary complaints, such as nausea, vomiting, and hematochezia. Mesenteric vein thrombosis has a mortality rate of 15% to 40%; early diagnosis plays an important role in treatment. An 80-year-old male patient presented at the Near East Universiry emergency department with complaints of fever and abdominal pain, underwent contrast-enhanced abdominal computed tomography, and was diagnosed with thrombosis in the ileocolic branch of the superior mesenteric vein. The complaints were treated with low molecular weight heparine (LMWH), and surgical intervention was not necessary.