Small Bowel Infarction or Necrosis Due to Mesenteric Venous Thrombosis

ABSTRACT

Acute mesenteric infarction due to mesenteric venous thrombosis was first reported by Elliot in 1895. In 1925 Warren and Eberhard characterized mesenteric venous thrombosis as an unique disease. PURPOSE: Mesenteric venous thrombosis is responsible for 5~15% of causes in acute mesenteric infarction. There are idiopathic thrombosis that has no specific causative disease and secondary thrombosis due to intraabdominal infection, tumor, portal hypertension, hematologic disorders and trauma to portal venous system etc. A diagnosis is made by Duplex scan, CT, MRA and angiography. CT has a 90% sensitivity rate. Bowel wall thickening and ascites are observed in advanced state. Angiographay can be used when the diagnosis is uncertain. Mortality is reported as high as 13~50% and major complications include short bowel syndrome, wound infection and sepsis etc. METHOD: We exprienced two patients (male 36 year old, male 47 year old) presented with acute abdominal pain who proved to have small bowel infarction due to mesenteric thrombosis. RESULT: Both patients showed signs of panperitonitis. CT examination showed portal-superior mesenteric venous thrombosis, small bowel infarction and large amout of ascites in either case. Small bowel resection and thrombectomy in one case and only small bowel resection in the other case were carried. Progressive postoperative fever and abdominal pain developed in one patient and intraabdominal absecess showed on CT examination. We performed secondary operation in the 9th postoperative date. CONCLUSION: The diagnosis of mesenteric venous thrombosis is difficult and small bowel resection should be performed when necrotic small bowel was encountered on exploration. Postoperative anti-coagulation therapy is reported to reduce recurrence and mortalty rate.