Alcohol Abuse and Unusual Abdominal Pain in a 49-Year-Old

Gregory Taylor, DO; Michael Semple, DO; Matthew Warpinski, DO

Disclosures

October 02, 2020

Discussion

Acute mesenteric vein thrombosis (MVT) is a rare but extremely important cause of mesenteric intestinal ischemia. In this patient, CT of the abdomen/pelvis with intravenous contrast revealed a filling defect that was consistent with acute thrombosis within the superior mesenteric vein (SMV), which extends approximately 3 cm cephalad to the portosplenic confluence. Other associated findings on these images included peripancreatic fat stranding and peripancreatic fluid consistent with acute pancreatitis (Figures 1-3).

Figure 1.

Figure 2.

Figure 3.

Pancreatitis results in a vast spectrum of both arterial and venous complications. The vascular complications involved in pancreatitis are major causes of morbidity and mortality. The venous complications result from thrombosis of the splenic vein and, less commonly, the portal vein and the SMV, as seen in the patient in this case. Prompt recognition is of paramount importance and requires a high index of clinical suspicion because aggressive therapy and anticoagulation can limit progression of the potential devastating consequences.

Patients with acute pancreatitis can present with portal vein thrombosis, splenic vein thrombosis, or (less commonly) superior MVT. Clinical research has shown that an isolated venous thrombosis to only the SMV, without simultaneous involvement of either the portal vein or the splenic vein, is rare. This vascular complication is important because of the increased risk for mesenteric ischemia and bowel infarction if not recognized.[1]

MVT is considered a rare condition, with only 1 case per 5000-15000 inpatient admissions per year; it accounts for roughly 6%-9% of all cases of acute mesenteric ischemia.[2] In a systematic review of 3692 patients from 1966 to 2002, MVT was the cause of acute mesenteric ischemia in about 3% of patients.[3]

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