Superior mesenteric vein thrombosis as a complication of acute appendicitis : report of a case

Abstract

Since superior mesenteric vein thrombosis (SMVT) is a relatively rare disease and shows no specific symptom, its diagnosis tends to be delayed. In this report, we present a patient in whom acute appendicitis was complicated by SMVT and portal vein thrombosis (PVT). A definitive diagnosis could be made by abdominal contrast-enhanced CT, and acute appendicitis was surgically treated. Anticoagulant therapy was continued for about half a year after surgery. Abdominal contrast-enhanced CT after discharge showed no recurrence of SMVT or PVT. We consider that acute appendicitis induced SMVT or PVT caused by the effect of inflammation. There is the possibility that these conditions lead to intestinal congestion or necrosis and liver dysfunction; appropriate diagnosis and treatment are necessary.

Intestinal Infarction Caused by Thrombophlebitis of the Portomesenteric Veins as a Complication of Acute Gangrenous Appendicitis After Appendectomy

“…There are several possible mechanisms of thrombogenesis in this condition: Thrombi are formed locally in the portomesenteric veins due to the hypercoagulability state caused by abscesses in the mesoappendix; Angiitis such as portal vein phlebitis occurs when the bacteria infiltrate into the portomesenteric veins; and Organisms invade into tissues around the veins to cause periphlebitis along the portomesenteric vessels, and when inflammation extends into the vascular lumens, thrombus forms. 4 In our patient, thrombus in both the mesentery veins of small bowel and the portomesenteric veins were confirmed during the 2nd operation. However, the histological results of the resected appendix revealed neither thrombus in the mesenteria vessels nor local abscesses in the mesoappendix, and the culturing results of both blood and the IV thrombus were negative.…”

“… 1 , 3 However, the reported mortality rate of pylephlebitis from all causes is still as high as 30 to 50%. 1 , 4 This is partly because of the delay in the diagnosis due to nonspecific manifestation and a low index of suspicion, which might lead to intestinal infarction, liver abscess, and septic shock.…”

Recurrent Abdominal Pain after Laparoscopic Appendectomy

“…8,9 However, it has previously been reported that laparoscopic appendectomy itself induced SMV thrombosis. 10 In our case, there was no evidence of PVT from a pre-operative abdominal CT scan.…”

A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis

“…Bacteria spread into tissues around the veins, cause periphlebitis along the vessels, and as inflammation extends into the vascular lumens, coagulation cascade is promoted, leading to thrombus formation. 6 Coagulation was facilitated via its surface and capsular components. The surface component accelerates fibrin cross-linking and the capsular polysaccharides initiate the clotting cascade by activating macrophages.…”