Mesenteric venous thrombosis complicating a case of acute appendicitis

A 29-year-old male presented with a 1-week history of nausea, vomiting, fevers, and chills. At presentation he was febrile, tachycardic, and exhibited right-sided abdominal pain. Initial workup revealed a white blood count of 13.1, bilirubin 4.3, and mild elevation of transaminases. Computed tomography (CT) scan of the abdomen and pelvis revealed a thickened distal terminal ileum, a dilated and inflamed appendix with an appendicolith (Fig 1), and a nonocclusive thrombus within the superior mesenteric vein (Fig 2).
Source: Surgery - Category: Surgery Authors: Source Type: research

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Rationale: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. Patient concerns: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Rationale: Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction. Patient concerns: In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending co...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
ConclusionIdiopathic omental infarction should be included in the differential diagnoses while treating patient with acute abdomen.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
We report on a 13-year-old boy who lived in Taipei City and who had initially tentative diagnosis of acute pyrexia of unknown origin with high fever up to 40.3°C for 1 week, but later had thrombocytopenia and diffuse abdominal pain with peritoneal sign suspected acute appendicitis. During the clinical course, septic shock and disseminated intravascular coagulopathy (DIC) were noted. There were skin rash in his trunk and extremities and an eschar with black crust surrounded by a scaling erythematous rim on his right buttock. In addition, we got the information of his travel history in Green Island and Orchid Island for ...
Source: The American Journal of Dermatopathology - Category: Pathology Tags: Extraordinary Case Report Source Type: research
Rationale: Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in successful treatment of such a life-threatening condition. Patient concerns: A 33-year-old male presents with a 4-day history of right lower abdominal pain, nausea and subjective fever. CT scan showed acute appendicitis and a central filling defect in the superior mesenteric vein. Diagnoses: Acute appendicitis complicated by SMVT. Interventions: Intravenous antibio...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion:Nobody would miss the precordial ST-depressions in this case. The problem is not in identifying these abnormalities, but rather in identifying their etiology.  Patients with Isolated Posterior STEMI often do not receive appropriate reperfusion therapy simply because infarction of this anatomical area of the myocardium may manifests without ST Elevation on standard 12-Lead ECG. Tips for recognizing Acute Posterior STEMI:1. Pattern recognition is one of the most powerful - and often subconscious - mechanisms by which we read ECGs. Remember this classic pattern of Posterior STEMI of Standard 12-Lead ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
​The differential list of potential causes of abdominal pain is pretty long. Like most differentials, though, it usually boils down to a handful of more common etiologies benign and serious. Potentially life- or organ-threatening conditions such as appendicitis, diverticulitis, or ovarian or testicular torsion simply cannot be misdiagnosed and usually aren't missed.​We frequently find ourselves walking into the patient's room at the end of an extensive and exhaustive workup and announcing the good news that the cause of the pain isn't one of these more serious causes. As emergency physicians working in an uncontrolled ...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Abstract Laparoscopic surgical approaches, compared with open surgical approaches, provide comparable clinical outcomes, but lower complications. Unfortunately, a rare complication-portomesenteric vein thrombosis-had been reported after laparoscopic surgery. A 42-year-old woman was referred our hospital for recurrent abdominal pain after laparoscopic appendectomy from acute appendicitis. It was determined that abdominal pain was due to postoperative superior mesenteric vein thrombus. A six-month anticoagulation therapy is an excellent treatment for superior mesenteric vein thrombus . Therefore, physicians should b...
Source: Korean J Gastroenter... - Category: Gastroenterology Authors: Tags: Korean J Gastroenterol Source Type: research
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Source: Journal of Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Case Report Source Type: research
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