engleski

Unspecific Upper Abdominal Pain Caused by Portomesenteric Vein Thrombosis-Case Report

INTRODUCTION: Superior mesenteric vein (SMVT) and portal vein thrombosis (PVT) is an uncommon, but life threatening condition with possible severe consequences, such as small bowel ischemia or portal hypertension. CASE REPORT: A 43-year-old male patient was admitted to the emergency department with symptoms of persistent and unspecific upper abdominal pain, combined with nausea and vomiting intermitently present for the last two weeks. Physical examination demonstrated generalized abdominal tenderness without signs of peritonitis. An emergency CT scan showed no significant findings. During the fifth day of hospitalization the patient's clinical status worsened with pain intensification. A control CT scan revealed extensive intraabdominal vein thrombosis, affecting the portal vein with intrahepatical branches, splenic vein and superior mesenteric vein with it's branches, combined with hypoperfusion of the liver, ascites and small bowel congestion. Anticoagulation therapy was set at the time of diagnosis with weight-based low-molecular-weight heparin (LMWH). Despite treatment, the patient developed clinical signs of acute bowel obstruction due to CT-confirmed small bowel ischaemia with initial necrosis. Emergency surgical procedure was made, with almost complete jejunal resection. Jejunoileal anastomosis was formed later when adequate perfusion of the remaining bowel was confirmed. Postoperatively the patient initially received total parenteral nutrition. Diagnostic tests performed for prothrombotic and antithrombotic factors were normal. A JAK2V617F mutation was discovered raising the suspicion of a latent chronic myeloprolypherative disorder. The patient gradually made a full recovery over the next three weeks and was discharged with continuation of LMWH. CONCLUSION: The presentation of portomesenteric vein thromobosis is non-specific and as a result, the diagnosis is often delayed or incidental. Our main goal was to show the importance of considering portomesenteric vein thrombosis as possible differential diagnosis of unexplained severe epigastric abdominal pain and the need for early diagnosis combined with medical and surgical treatment to achieve a successful outcome.

Anastomosis ; Ascites ; Ischaemia ; Thrombosis

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