Superior metric vein thrombosis ( SMV ) leading to bowel ischaemia in a young male patient ( Vessel blockage leading to Gangrene of Intestines )

Thrombosis of the superior mesenteric vein is an uncommon but potentially life-threatening disorder. Superior Mesenteric vein thrombosis describes acute, subacute, or chronic thrombosis of the superior or inferior mesenteric vein or branches.It  may present with acute abdominal pain or may be an asymptomatic incidental finding on abdominal imaging. Accounts for 1 in 5000 to 15 000 inpatient admissions and 1 in 1000 emergency surgical laparotomies for acute abdomen.Dr Ankur Mishra,Consultant-General and Laparoscopic Surgeon,Wockhadrt Hospital,Nagpur said that,The incidence of SMV has increased over the past 40 years, likely as a result of the greater use of abdominal CT Scan  followed by diagnostic Laparoscopy .Age at presentation varies, more predominant in males, although it is most common in the fifth and sixth decades of life. 

Its cause may be clear, as in patients with adjacent neoplasm or inflammation or in patients with cirrhosis or portal vein thrombosis. Alternatively, the etiology and hence therapy may be more difficult to determine if no definite cause is seen. In general, superior mesenteric vein thrombosis has an acute or subacute presentation. It may mimic the findings in acute mesenteric arterial ischemia. Commonly, however, the presentation is less classic and severe. In a study by Rhee et al 75% of patients had been symptomatic for longer than 48 hr at the time of presentation. Diagnosis was also frequently delayed. These findings are consistent with the variable nature of both the clot itself and its impact on the bowel circulation.

Dr Ankur Mishra,Consultant-General and Laparoscopic Surgeon,Wockhadrt Hospital,Nagpur further added,We had a 27 year old male patient who came to casualty with history of pain abdomen since last 10 to 12 days following which he took primary treatment but again and again he had pain abdomen which was not relieved on medication for which he visited our hospital and on initial presentation he was well conscious and oriented and had diffuse abdominal pain with nausea ,vomiting and he had tachycardia his blood pressure was within normal limits. Admitted in ICU and got a CECT scan done of abdomen and pelvis in which it showed blockage ( of blood vessels  )involving superior mesentric vein , splenic vein, portal vein .

He underwent surgery diagnostic laparoscopy and exploratory laparotomy , Intra operatively he had small bowel gangrene  involving a segment of around 40-50 cm long small Intestine . His intestine were resected and anastomosis done . Post operatively patient was shifted to ICU and was well managed by our critical care team and staff, post surgery he stayed in ICU for around 4 to 5 days and then he was shifted to ward , normal diet was started and then discharged from hospital .Further follow up after 15 days patient was doing well and tolerating well normal diet and had no any major complaints.

Its recommended to out public that if there is any kind of pain which is out of proportion and is not getting relieved on painkillers or analgesics better to get a ultra sonography or a CT scan of abdomen and pelvis so that this Pathology could be picked up at the earliest and proper intervention is being done.