Computed tomography of superior mesenteric vein thrombosis following appendectomy

Abstract

During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after an appendectomy. No sign of SMV was present at appendectomy, and a period of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, the appendicitis was complicated. These patients had nonspecific signs and symptoms, although two of them had elevation of blood hepatic enzyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an intraluminal clot. In one case, CT showed extension of the thrombus to the portal vein with the presence of low-attenuation areas in the liver, consistent with hepatic infarcts. Two patients had predisposing diseases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicitis, and early appendectomy in appendicitis can prevent this complication. Moreover, as in any abdominal surgery, early appendectomy may be complicated by thrombosis of the SMV, thus creating problems of postoperative diagnosis. The complication is more frequent when the initial operation is performed under difficult conditions (peritonitis), or when the patient presents with a coagulopathy. CT is useful in the diagnosis of SMV thrombosis, thus leading to early management with anticoagulant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction.

Hypercoagulopathy with Piperacillin Administration in Osteomyelitis.

“…CT has a high sensitivity and specificity for diagnosing splanchnic venous occlusion. With contrast-enhanced CT, SMVthrombosis is characterized by decreased intraluminal density, occasionally combined with a ringed enhancement of the vessel due to opacification of the vasa vasorum (19). In the present case as well, contrast-enhanced CT was useful in diagnosing SMVthrombosis.…”

Portal Vein Thrombosis in Pregnancy: Case Report and Review of the Literature

“…6,15 Also, unlike MRI and 3D magnetic resonance portography with contrast, color Doppler is more widely available, cheaper and feasible on emergency basis. 16,17 Anyway, in our case, CT and MRI were contraindicated because of the first trimester-pregnancy.…”

“…1,5 In adults, PVT usually complicates myeloproliferative disorders, cirrhosis, and may occur months or years after abdominal trauma, abdominal surgery, acute pancreatitis or appendicitis. 6 Use of oral contraceptives particularly in older women can be complicated by PVT. 2 The hypercoagulable state of pregnancy predisposes to this condition.…”

“…1 Prompt treatment of PVT is essential in order to prevent extension to superior mesenteric vein, splenic vein and hepatic vein which could lead to development of hepatic or mesenteric infarction. 6,8 Prompt treatment could also prevent progression to portal hypertension with risk of variceal hemorrhage. 5,9,10 Furthermore, early treatment could result in complete lysis of the clot, as was observed in our patient.…”

Superior mesenteric vein thrombosis

“…1 CT has been found to be effective in the diagnosis of SMV thrombosis, [2][3][4] with CT findings of mesenteric congestion and bowel wall thickening associated with ischaemia. …”