Acute superior mesentric vessel thrombosis with bowel ischemia – Case series

Background: Acute mesenteric ischemia consists of the sudden, partial or complete, interruption of the blood flow in superior or inferior mesenteric vessels that result in intestinal ischemia. The incidence was exponentially increasing with age and no difference has been observed between sexes. Aim: The Aim of this case series was to highlight clinical presentation, the difficulty in diagnosis and importance of early intervention and the prognosis of superior mesentric vessel thrombosis with bowel ischemia. This article presented a case series of intestinal infarction through obstruction of superior mesenteric vessels – three cases of acute mesenteric artery thrombosis, two case of acute mesenteric vein thrombosis. Materials and methods: The materials for this case series was collected from patients diagnosed and admitted as acute superior mesentric vessel thrombosis in various surgical units in Department of General Surgery, Govt. Stanley Medical College, Chennai. All 5 cases have been analyzed for this study during period of 6 months from January 2016 to June 2016. All Cases with superior mesentric vessels thrombosis were included. No exclusion criteria. Results: This case series consisted of 5 cases, three cases of acute mesenteric artery thrombosis and two case of acute mesenteric vein thrombosis. In this case series, superior mesentric artery thrombosis was more common with male preponderance. 4 out of 5 cases were male in which Superior mesenteric artery was more common when compared to vein thrombosis. Out of 5 cases, 2 cases were asymptomatic with mild abdominal discomfort. Most common complaints of 5 cases were sudden onset of abdominal pain with or without vomiting. Abdominal distension/ Constipation were not seen in all cases. Out of 5 cases, 4 patients were on favorable follow up in which 2 cases had been diagnosed very early who had less post-operative stay and no complications after surgery. 2 cases developed post op complications. 1 case had deceased because of late presentation. This case series presentation draws to attention that timely diagnosis and appropriate surgery with resection and immediate postoperative heparinization and proper follow up with anti coagulant the morbidity and mortality is averted. Conclusion: The diagnosis of AMI is difficult and mostly delayed resulting in irreversible bowel ischemia which requires emergency intervention. Mortality and morbidity for AMI remains high, and in patients requiring extensive bowel resection the survival rate was low. As AMI mostly affects the elderly population physicians have to be aware of the possibility of this condition when facing the elderly patient even with mild sudden onset of abdominal pain complaints. An interdisciplinary collaboration is must, since patients are not initially evaluated by surgeons.