Lin Bin, Zhang Yan-Ping, Xue Lin-Ying, Ye Ying, Tang Yi, Yang Chang Shun, Luo Jie-Wei, Gao Mei-Zhu, Fang Zhu-Ting
Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Department of Geriatrics, Fujian Provincial Geriatric Hospital, Fuzhou, China.
Front Surg. 2023 Jan 9;9:988195. doi: 10.3389/fsurg.2022.988195. eCollection 2022.
Superior mesenteric vein (SMV) thrombosis is a rare intestinal ischemic disease. The clinical manifestations of patients differ, and most experience gastrointestinal symptoms.
A 45-year-old female patient presented with persistent abdominal pain and abnormal vaginal bleeding for 7 days. A physical examination revealed significant abdominal tenderness with positive rebound tenderness. A laboratory examination revealed a white blood cell count of 27 × 10/l, hemoglobin level of 52 g/L, and D-dimer of 4.54 mg/l. Enhanced computed tomography revealed a thickening and swelling of the jejunum and ileum in the left upper quadrant and portal vein. Filling defects in the main lumen and branch lumen suggested the possibility of portal vein and superior mesenteric vein thrombosis. Symptoms improved after treatment with low-molecular-weight heparin and warfarin. One month later, the patient developed occasional dull pain in the left lower quadrant, with long strips of discharge. An electronic colonoscopy revealed avascular necrosis and tissue exfoliation of the intestinal mucosa. After the continuation of warfarin therapy, the abdominal pain resolved. Five months later, the patient experienced recurrent abdominal pain and vomiting. A physical examination revealed a blood pressure of 75/49 mm Hg. An incomplete ileus with the portal and superior mesenteric vein thrombosis was diagnosed, partial jejunectomy and gastrointestinal bypass anastomosis were performed, and warfarin was continued postoperatively.
The intestinal mucosal shedding observed, in this case, was caused by SMV thrombosis, which enriched the clinical manifestations of the disease and provided a new basis for the clinical diagnosis of SMV thrombosis.
肠系膜上静脉（SMV）血栓形成是一种罕见的肠道缺血性疾病。患者的临床表现各异，多数有胃肠道症状。
一名45岁女性患者出现持续腹痛和异常阴道出血7天。体格检查发现腹部压痛明显，反跳痛阳性。实验室检查显示白细胞计数为27×10⁹/L，血红蛋白水平为52g/L，D-二聚体为4.54mg/L。增强CT显示左上腹空肠和回肠以及门静脉增厚、肿胀。主腔和分支腔内的充盈缺损提示门静脉和肠系膜上静脉血栓形成的可能性。经低分子量肝素和华法林治疗后症状改善。1个月后，患者左下象限偶尔出现隐痛，有长条状分泌物。电子结肠镜检查显示肠黏膜无血管性坏死和组织脱落。继续使用华法林治疗后，腹痛缓解。5个月后，患者再次出现腹痛和呕吐。体格检查显示血压为75/49mmHg。诊断为不完全性肠梗阻伴门静脉和肠系膜上静脉血栓形成，行部分空肠切除术和胃肠旁路吻合术，术后继续使用华法林。
本病例中观察到的肠黏膜脱落是由SMV血栓形成引起的，丰富了该疾病的临床表现，为SMV血栓形成的临床诊断提供了新依据。
