Silent Strangler: Missed Mesenteric Vein Thrombosis Uncovered Surgically

In this case report, we describe a case of mesenteric venous thrombosis (MVT) in a 66-year-old male with a pertinent medical history of coronary artery disease, hypertension, hyperlipidemia, and prior conservatively managed partial small bowel obstruction.The patient presented with the nonspecific symptoms of acuteonset nausea and multiple episodes of nonbloody, nonbilious emesis, precipitating presentation to the emergency department.Initial CT imaging of the abdomen and pelvis demonstrated only findings that were consistent with a partial small bowel obstruction or ileus.There was no evidence of any MVT, so the patient was started on supportive care and empiric antibiotics.However, the patient continued to have persistent symptoms and was eventually taken for an exploratory laparotomy.During this operation, surgeons discovered a segment of mid-to-proximal jejunum consistent with MVT.This report demonstrates the challenges of diagnosing and managing MVT.First, MVT may mimic other diagnoses and present with nonspecific symptoms, which can delay diagnosis.Additionally, preoperative CT is a very useful tool for diagnosing MVTs, but it is not immune to false-negative results that can delay treatment.As such, a negative CT finding should not definitively eliminate MVTs from a differential list.Finally, treatment of MVT, once diagnosed, can extend all the way to exploratory surgery, with medical management before and after surgery being of vital importance.