Thrombosis of portal, mesenteric, and splenic vein

Clinical History

36-year-old female patient with abdominal pain during the last 15 days. No relevant medical history, except an abortion several years ago. Started with oral contraceptives three months ago.

Imaging Findings

This patient presented with a 15-days history of abdominal pain, located in the epigastrium, and haematemesis. Gastroscopy revealed acute erosions in the gastric mucosa.
Abdominal ultrasound yielded absence of flow in the portal vein with presence of intraluminal echogenic material, a small bowel segment with wall thickening, and free intraperitoneal fluid.
Contrast enhanced CT (CE-CT) confirmed portal, mesenteric and splenic vein thrombosis, and demonstrated a jejunum segment with thickened and edematous wall, findings that suggested ischaemic damage secondary to venous obstruction.
Emergency surgery was performed and 60 cm of ischemic jejunum had to be resected. The patient recovered well.

Discussion

Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischaemia. Doppler ultrasonography allows direct evaluation of the mesenteric and portal veins, provides semiquantitative flow information, and allows Doppler waveform analysis of the visceral vessels; however, it is operator dependent and often limited by overlying bowel gas. CE-CT allows sensitive detection of venous thrombosis in large vessels of the portomesenteric circulation and any associated secondary findings. Mesenteric venous thrombosis can be classified on the basis of its cause as primary or secondary. Spontaneous, idiopathic thrombosis of the splanchnic veins not associated with any predisposing conditions has been termed primary mesenteric venous thrombosis. Conditions and factors associated with portomesenteric venous thrombosis are abdominal surgery, inflammation (such as pancreatitis, appendicitis, inflammatory bowel disease, diverticulitis), hypercoagulable states, blunt abdominal trauma, pregnancy, portal hypertension, liver cirrhosis, and intake of oral contraceptives.

Differential Diagnosis List

Final Diagnosis

Thrombosis of portal, mesenteric and splenic vein with secondary bowel ischaemia

URL:	https://www.eurorad.org/case/8733
DOI:	10.1594/EURORAD/CASE.8733
ISSN:	1563-4086