Case Report

Mesenteric Venous Thrombosis in a Patient with Pancreatitis and Protein C Deficiency

Authors: Andrew Rackoff, MD, Nathan Shores, MD, Ira Willner, MD

Abstract

Mesenteric vein thrombosis is an uncommon manifestation of hypercoagulable states. A case is reported of superior mesenteric vein (SMV) thrombosis in a patient with pancreatitis and protein C deficiency. A discussion of SMV thrombosis identification, management, and outcomes is included. The patient presented with a significant history of alcohol abuse and constant, midepigastric abdominal pain associated with nausea and vomiting. Amylase and lipase were elevated, and the patient was treated for pancreatitis. His symptoms initially responded to intravenous fluid hydration, but soon his clinical picture worsened, with increased nausea and vomiting, abdominal pain, and distension. Contrasted computed tomography of the abdomen revealed SMV thrombosis. A hypercoagulable workup revealed protein C deficiency. After a 3-month course of oral anticoagulant therapy, the SMV thrombosis resolved.


Key Points


* A high index of suspicion must be maintained for superior mesenteric vein thrombosis in a patient with vague abdominal pain and appropriate risk factors.


* The key to successful treatment and best prognosis is early recognition of disease and initiation of anticoagulation.


* Therapeutic anticoagulation for at least 3 months is required for resolution of superior mesenteric vein thrombosis.

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