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Superior mesenteric vein thrombosis after colectomy in a patient with Crohn's disease

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 281–285 (2005)Cite this article

An Erratum to this article was published on 01 October 2005

Abstract

Background An 18-year-old woman with a history of Crohn's disease presented in January 2004 with severe epigastric pain, nausea and vomiting of 4 hours' duration. The patient was diagnosed with inflammatory bowel disease, thought to be consistent with ulcerative colitis, in March 2003, but had no medical history up until this point. Initial treatment with mesalamine was unsuccessful and she subsequently presented with medically resistant fulminant colitis and required an urgent colectomy in June 2003. Her immediate postoperative course was uneventful and she was discharged on tapering doses of prednisone. In August 2003, an ileoscopy revealed inflamed, mildly ulcerated mucosa, and biopsies were consistent with Crohn's disease. Azathioprine was added to the treatment regimen and the patient tapered off prednisone. At this stage the patient continued to do well clinically up until presentation.

Investigations Small bowel series, abdominal CT scan, abdominal ultrasound, exploratory laparotomy.

Diagnosis Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis.

Management Resection of necrotic bowel, antibiotics and systemic anticoagulation.

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Figure 1: Results of the small bowel series.
Figure 2
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References

  1. Go VL and Everhart JE (1994) Pancreatitis. In Digestive Diseases in the United States: Epidemiology and Impact, NIH Publication no. 94–1447 (Ed. Everhart JE) Washington: US Government Printing Office

    Google Scholar 

  2. Lapidus A et al. (1999) The prevalence of gallstone disease in a defined cohort of patients with Crohn's disease. Am J Gastroenterol 94: 1261–1266

    Article  CAS  Google Scholar 

  3. Triantafillidis JK et al. (2000) Acute idiopathic pancreatitis complicating active Crohn's disease: favorable response to infliximab treatment. Am J Gastroenterol 95: 3334–3336

    Article  CAS  Google Scholar 

  4. Weersma RK et al. (2004) Increased incidence of azathioprine-induced pancreatitis in Crohn's disease compared with other diseases. Aliment Pharmacol Ther 20: 843–850

    Article  CAS  Google Scholar 

  5. Parker MC et al. (2001) Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44: 822–829; discussion 829–830

    Article  CAS  Google Scholar 

  6. Lock G (2002) Acute mesenteric ischemia: classification, evaluation and therapy. Acta Gastroenterol Belg 65: 220–225

    PubMed  Google Scholar 

  7. Vicente DC and Kazmers A (1999) Acute mesenteric ischemia. Curr Opin Cardiol 14: 453–458

    Article  CAS  Google Scholar 

  8. McKinsey JF and Gewertz BL (1997) Acute mesenteric ischemia. Surg Clin North Am 77: 307–318

    Article  CAS  Google Scholar 

  9. Fichera A et al. (2003) Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 46: 643–648

    Article  Google Scholar 

  10. Remzi FH et al. (2002) Portal vein thrombi after restorative proctocolectomy. Surgery 132: 655–661; discussion 661–662

    Article  Google Scholar 

  11. Kim AY and Ha HK (2003) Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies. Radiol Clin North Am 41: 327–342

    Article  Google Scholar 

  12. Laissy JP et al. (2002) MR angiography: noninvasive vascular imaging of the abdomen. Abdom Imaging 27: 488–506

    Article  CAS  Google Scholar 

  13. Rhee RY and Gloviczki P (1997) Mesenteric venous thrombosis. Surg Clin North Am 77: 327–338

    Article  CAS  Google Scholar 

  14. Nielsen HK (1991) Pathophysiology of venous thromboembolism. Semin Thromb Hemost 17 (Suppl 3): S250–S253

    Google Scholar 

  15. Solem CA et al. (2004) Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol 99: 97–101

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery,

    Andrew S Ross, Arunas Gasparaitis, Roger Hurst, Stephen B Hanauer & David T Rubin

  2. Section of Gastroenterology and Nutrition,

    Andrew S Ross, Arunas Gasparaitis, Roger Hurst, Stephen B Hanauer & David T Rubin

  3. University of Chicago, IL, USA

    Andrew S Ross, Arunas Gasparaitis, Roger Hurst, Stephen B Hanauer & David T Rubin

Authors
  1. Andrew S Ross
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  2. Arunas Gasparaitis
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  3. Roger Hurst
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  4. Stephen B Hanauer
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  5. David T Rubin
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Corresponding author

Correspondence to David T Rubin.

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Competing interests

The authors declare no competing financial interests.

Glossary

MESALAMINE

An aminosalicylate used for the treatment of mild to moderate inflammatory bowel disease

HARTMANN'S POUCH

The surgical creation of a rectal stump following a subtotal colectomy allowing for future re-anastomosis

PREDNISONE

A steroid often used in the treatment of moderate to severe inflammatory bowel disease

AZATHIOPRINE

An immunomodulatory agent often used in the treatment of moderate to severe inflammatory bowel disease for maintenance of remission and steroid sparing

PARTIAL THROMBOPLASTIN TIME

A laboratory test that measures the function of the intrinsic coagulation pathway

LIGAMENT OF TREITZ

The fibrous structure by which the junction between the duodenum and jejunum is fixed to the posterior wall of the abdominal cavity

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Ross, A., Gasparaitis, A., Hurst, R. et al. Superior mesenteric vein thrombosis after colectomy in a patient with Crohn's disease. Nat Rev Gastroenterol Hepatol 2, 281–285 (2005). https://doi.org/10.1038/ncpgasthep0195

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  • DOI: https://doi.org/10.1038/ncpgasthep0195

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