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Idiopathic superior mesenteric vein thrombosis leading to gangrenous ileum: A case report

Year: 2025

Type: article

Abstract: INTRODUCTION AND IMPORTANCE: Idiopathic superior mesenteric vein thrombosis (SMVT) is an uncommon but serious cause of mesenteric ischemia, accounting for 6-9 % of cases. Although SMVT is typically linked to hypercoagulable states, malignancy, or intra-abdominal inflammation, an idiopathic etiology persists in up to 25 % of cases even after exhaustive evaluation, underscoring diagnostic challenges and the need for vigilant workup. CASE PRESENTATION: A 46-year-old male presented with progressive abdominal pain, distension, and bilious vomiting. CECT identified SMVT with non-enhancing ileal loops, confirming gangrenous ileum. Emergency laparotomy revealed 100 cm of necrotic ileum, which was resected with ileostomy creation. Postoperative anticoagulation was initiated, and thrombophilia screening ruled out hypercoagulable disorders, classifying the SMVT as idiopathic. CLINICAL DISCUSSION: SMVT presents insidiously with abdominal pain, vomiting, and distension; late features include peritonitis and hemodynamic instability. CECT remains the diagnostic gold standard with >90 % accuracy. Management algorithms stratify patients by stability and ischemia severity: stable patients may respond to anticoagulation alone, while those with infarction require prompt surgical resection and possible stoma formation. Lifelong or extended anticoagulation is advocated in idiopathic cases to prevent recurrence. CONCLUSION: This case underscores that idiopathic SMVT, although rare and often diagnostically challenging, can rapidly progress to life-threatening bowel gangrene even in the absence of known risk factors. Timely diagnosis using contrast-enhanced CT and a multidisciplinary approach-including prompt surgical intervention and postoperative anticoagulation-are critical to improving survival and reducing long-term morbidity. This case reinforces the importance of maintaining a high index of suspicion and implementing early, coordinated management in suspected mesenteric ischemia.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111561

Authors: Samrat Shrestha, Kiran Bishwakarma, Bijay Raj Bhatta, Mecklina Shrestha, Rahul Jha

Institutions: Bir Hospital, National Academy of Medical Sciences, College of Medical Sciences

Language: English

Topic: Abdominal vascular conditions and treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090