Successful management of acute superior mesenteric infarction caused by extensive portal-mesenteric venous thrombosis: a case report.

BACKGROUND

Acute intestinal infarction caused by portal vein and mesenteric vein thrombosis (PVMVT) can be fatal and has a high mortality rate even if surgical resection is timely performed. The diagnosis of PVMVT is frequently delayed, which can be fatal owing to complications such as mesenteric ischemia and infarction with multiorgan failure. PVMVT-related intestinal infarction is extremely rare, with only sporadic cases reported in the literature around the world. In our study, we present a case of acute superior intestinal infarction secondary to extensive PVMVT that was successfully managed through prompt diagnosis and targeted intervention in a primary care center in China.

CASE DESCRIPTION: A 50-year-old man with no significant medical history presented at the emergency department with a 2-day history of severe abdominal pain and vomiting. Physical examination, laboratory investigations and Contrast-enhanced abdominal computed tomography revealed acute superior mesenteric infarction with extensive portal-mesenteric venous thrombosis. Given concern for acute superior intestinal necrosis, a diagnostic laparoscopy was performed. Then, the open surgery removed the infarcted intestinal segment and the mesenteric vein thrombosis (MVT), and performed an anastomosis and fixation of the sigmoid colon. Subsequently, percutaneous transhepatic portal vein angiography (PTPVA) was undertaken, followed by thrombectomy (TE), thrombolysis (TL), balloon angioplasty (BA), and stent placement. The patient was discharged home on postoperative day 15 with a prescription for long-term rivaroxaban. At the 2-month follow-up visit, he was recovering well and remains on long-term anticoagulation therapy.

CONCLUSIONS

Acute PVMVT is a rare and insidious disease that is associated with significant mortality and morbidity. Physicians must maintain familiarity with this rare condition to enhance patient quality of life and prevent intestinal infarction secondary to extensive PVMVT. This case underscores the importance of early recognition and multidisciplinary team (MDT) management, which may improve outcomes for affected patients globally.