Operative Management of Acute Mesenteric Venous Thrombosis With Extensive Intestinal Ischemia: A Case Report.

Acute mesenteric venous thrombosis (MVT) is a life-threatening emergency, as delayed treatment may result in bowel ischemia and high mortality. Diagnosis is often challenging due to non-specific symptoms, and management may be conservative or surgical. We report the case of a 52-year-old man who presented to the emergency department with abdominal pain and diarrhea. Although abdominal computed tomography (CT) did not confirm MVT, persistent clinical suspicion and the presence of metabolic acidosis prompted an exploratory laparotomy. Intraoperatively, extensive intestinal ischemia was identified, and given the patient's hemodynamic instability, damage control surgery was performed, including resection of necrotic bowel, temporary stoma formation, and temporary abdominal closure using the "sandwich" technique. After stabilization in the ICU, a second-look operation allowed for jejunocolic anastomosis, stoma reversal, and definitive abdominal closure. A postoperative venous-phase CT scan confirmed MVT. The patient was discharged after 13 days on anticoagulation, with subsequent diagnosis of Factor V Leiden thrombophilia. This case underscores the importance of maintaining high clinical suspicion for MVT despite inconclusive imaging, as timely surgical intervention can be life-saving.