P2726 - Septic Inferior Mesenteric Vein Thrombosis in a Patient With IBD

Erica Becker, MD, MPH¹, Dheera Grover, MBBS², Sanket Patel, DO², Lisa Rossi, MD^3
1University of Connecticut Health Center, Farmington, CT; ²University of Connecticut Health Center, Hartford, CT; ³Saint Francis Hospital, Hartford, CT

Introduction: Mesenteric vein thrombosis (MVT) is a life-threatening condition that has poor prognosis with a mortality rate ranging from 20% - 50%. Pylephlebitis is an uncommon complication of MVT that has been associated with inflammatory bowel disease (IBD). Studies suggest only 30% of patients with pylephlebitis have localizing symptoms. Although this is a severe condition that can lead to significant sequelae, there is often a delay in diagnosis as clinical symptoms can be non-specific. Thrombosis typically occurs in the superior mesenteric vein (SMV) and current literature reports a 5% prevalence of inferior MVT. We present a case of septic inferior MVT in a patient with active UC.

Case Description/Methods: 62-year-old male with active ulcerative colitis (UC) s/p Remicade 2 weeks prior presented with one day history of chills, diaphoresis, and generalized abdominal. CT abdomen/pelvis revealed inferior MVT involving its branches as well as the splenic vein with foci of air and significant colitis of the distal transverse and left colon. Blood cultures were positive for Strep Group C. The patient was promptly started on antibiotics and intravenous heparin with response without requiring surgical intervention. Upon discharge, he was transitioned to lovenox for a duration of at least 6 months. His acute UC flare was subsequently treated with a prednisone taper upon discharge and he was later started on vedolizumab.

Discussion: The SMV drains the second portion of the duodenum to the right 2/3 of the transverse colon; whereas, the IMV drains the remaining 1/3 of the transverse colon, descending and sigmoid colon, and rectum. Although it is unclear why the superior mesenteric vein is more commonly thrombosed, studies suggest that MVT’s are found within the same territory in which IBD is located. Our case follows a similar presentation. The prevalence of MVT remains unknown within the IBD population; however, the risk seems to be increased and is speculated to be eight times higher during a flare. Bowel wall inflammation and localized venous engorgement from MVT could be correlating factors. Septic MVT is a medical emergency with the potential to have poor prognosis. Symptoms may be absent, nonspecific, or masked by the IBD flare; thus, it should be considered in the differential diagnosis of patients with IBD flare. Poor outcomes such as septic shock, ARDS, abscess, perforation, surgical intervention or death may be avoided with prompt diagnosis and treatment with anticoagulation and antibiotics.




Disclosures:


Erica Becker, MD, MPH¹, Dheera Grover, MBBS², Sanket Patel, DO², Lisa Rossi, MD³. P2726 - Septic Inferior Mesenteric Vein Thrombosis in a Patient With IBD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.