Junaid Mir, MD1, Sherry Soenen, MD2 1Wellspan York Hospital, York, PA; 2Wellspan, York, PA
Introduction: Abdominal pain is one of the most common complaints encountered in the emergency department but has a broad variety of causes leading to diagnostic challenges. Imaging plays a significant role in diagnosis but there are pitfalls to selecting and interpreting imaging studies. Here, we present a rare case of inferior mesenteric vein thrombophlebitis.
Case Description/Methods: A 75-year-old male presented with mild generalized abdominal pain, nausea, and loss of appetite for 3 days. PMH included colon diverticula. Physical exam was notable for temp 99.2F and mild left lower quadrant tenderness. Lab workup was significant for elevated CRP and ESR. Infectious workup including blood cultures was negative. CT abdomen was negative for diverticulitis, however showed inferior mesenteric vein thrombus and fat stranding (fig 1). MRI venogram confirmed inferior mesenteric thrombophlebitis. Ultrasound confirmed the absence of portal vein thrombus. He was started on broad-spectrum antibiotics, then de-escalated to Amoxicillin/Clavulanic acid. He was also started on heparin and improved. He was then discharged on warfarin to follow up with hematology as an outpatient.
Discussion: Inferior mesenteric vein thrombophlebitis is a rare cause of abdominal pain and fever. Diagnosis is often delayed by nonspecific symptoms. Complications can be life-threatening, including bowel infarction with peritonitis as well as portal and/or splenic-vein thrombosis, which can lead to variceal hemorrhage. Mortality rates range from 20 to 50%. A specific etiology is usually present - underlying causes include local inflammatory diseases like pancreatitis, diverticulitis or inflammatory bowel disease, trauma, cirrhosis, and thrombotic disorders or other prothrombotic states. Patients should be screened for thrombophilia. CT is the test of choice, although MRI also has excellent sensitivity and specificity. IV contrast increases the sensitivity of CT and should be used. Anticoagulation should be initiated as soon as possible after the diagnosis is made, as it has been shown to decrease mortality. Patients with a known cause but no thrombotic disorder are often treated for 6 to 12 months; for other patients, treatment is lifelong. Antibiotics are typically used given the risk of bowel infarction, however, data for their use is limited. Our patient’s case is unique as no infection source or thrombophilia was found.
Junaid Mir indicated no relevant financial relationships.
Sherry Soenen indicated no relevant financial relationships.
Junaid Mir, MD1, Sherry Soenen, MD2. P2319 - Rare Case of Inferior Mesenteric Vein Thrombophlebitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.