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


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


METHODS
Acute mesenteric ischemia secondary to superior mesenteric vein thrombosis.


RESULTS
Resection of necrotic bowel, antibiotics and systemic anticoagulation.
Ross
Andrew S
AS
Department of Surgery, University of Chicago, IL, USA.
Gasparaitis
Arunas
A
Hurst
Roger
R
Hanauer
Stephen B
SB
Rubin
David T
DT
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D003951:Diagnostic Errors; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply / Q000601:surgery; D008642:Mesenteric Veins; D010289:Parenteral Nutrition, Total; D012778:Short Bowel Syndrome / Q000209:etiology / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology*
D000925:Anticoagulants