Acute Intestinal Obstruction secondary to Superior Mesenteric Vein Thrombosis Managed with Endovascular Stenting: A Case Report

Ma. Felina Rosana Siray MD, Roel Galang, MD, Maria Alessandra Simeon MD, Ellani Louise Huilar MD, Maxine Garcia MD, Tim Lawrence Lin MD
Institute of Digestive and Liver Diseases, St. Luke’s Medical Center, Global City, Philippines

Significance: Superior Mesenteric Vein (SMV) Thrombosis accounts for only 5% of all cases of intestinal ischemia. As opposed to acute mesenteric ischemia secondary to an arterial thrombus which has a more abrupt presentation, SMV thrombus typically presents with non-specific signs and symptoms. Rarely, when venous congestion leads to bowel wall edema, there is consequent luminal narrowing, thereby producing symptoms of obstruction.

Clinical Presentation: We present the case of a 47-year-old male presenting with severe generalized abdominal pain and vomiting. Abdominal CT findings were suggestive of small bowel obstruction and venous thrombosis. CT angiogram confirmed SMV thrombus which was visualized as severe narrowing of the SMV at the midabdomen a few centimeters above the umbilicus, with consequent congestion and decreased contrast enhancement proximal to the area of narrowing. The patient was initially managed conservatively with anticoagulation, but there was no clinical improvement. Since there were no signs of infarction or peritonitis that would warrant immediate surgical intervention, an alternative approach using endovascular technique was attempted. The patient underwent SMV stenting, which subsequently relieved the obstruction. This case emphasized that mesenteric ischemia should be considered among patients presenting with small bowel obstruction. Anticoagulation should not be delayed in cases of SMV thrombosis, but if the patient shows little to no improvement with conservative management, new treatment options should be explored. Endovascular stenting provides a less invasive but effective means of revascularization that consequently relieves bowel obstruction.

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