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• W3209918282 abstract "Introduction: Acute Mesenteric Venous Thrombosis (MVT) manifesting as acute mesenteric ischemia is life threatening and remains high on the differential in patients with severe abdominal pain. However, subacute and chronic MVT with vague symptoms including abdominal pain, nausea, vomiting, are more difficult to discover and remain undiagnosed before presenting with catastrophic consequences. Case Description/Methods: A 27-year-old non-pregnant female with a history of Polycystic Ovary Syndrome presented with a month long postprandial, periumbilical pain, nausea with vomiting and was discharged with a diagnosis of viral gastroenteritis. Five days later, she presented again with similar complaints. CT showed inflammatory changes in proximal and jejunal loops. Given her non-toxic appearance, she was discharged again with a diagnosis of enteritis. Two weeks later, patient presented with ongoing abdominal pain. CT enterography showed small bowel dilatation, concerning for small bowel obstruction, and superior mesenteric vein and portal vein thromboses. A repeat CT showed mesenteric edema and pneumatosis in the jejunum. Patient was conservatively managed in the interim. However, a subsequent MRI abdomen now showed ischemic changes in proximal jejunum and ileum with physical exam concerning for acute abdomen. She was taken for urgent exploratory laparotomy and was found to have mesenteric ischemia requiring small bowel resection. A re-read of all images showed presence of MVT thrombosis in the first CT scan progressing to enteritis and later small bowel obstruction, eventually leading to mesenteric ischemia. There was no family history of hypercoagulability disorders, malignancy, and no personal history of alcohol, smoking, illicit drugs, or oral contraceptives use. Hypercoagulable workup revealed positive Lupus Anticoagulant, with repeat positive tests at 12 weeks confirming the diagnosis of Antiphospholipid Antibody Syndrome. Patient was treated successfully with monotherapy Enoxaparin. Discussion: Subacute abdominal pain in non-toxic appearing, young, healthy individuals can be deceiving and should warrant careful review before being dismissed as enteritis, especially when no symptom resolution is achieved over a period of time. A small bowel obstruction in such individuals with no risk factors require a high degree of suspicion for potential causes, including MVT. CT Angiography remains the gold standard for MVT diagnosis. Prompt treatment with anticoagulation is necessary to prevent future complications.Figure 1.: Figure 1a. Intraoperative findings of two resected segments of necrosed small bowel Figure 1b. CT Abdomen and Pelvis with pneumatosis along the medial wall of the jejunal small bowel loop." @default.
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• W3209918282 date "2021-10-01" @default.
• W3209918282 modified "2023-09-27" @default.
• W3209918282 title "S3032 Mesenteric Venous Thrombosis Hiding as Enteritis" @default.
• W3209918282 doi "https://doi.org/10.14309/01.ajg.0000785660.33480.83" @default.
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