SUPERIOR MESENTERIC AND PORTAL VEIN THROMBOSIS WITH HYPERHOMOCYSTEINEMIA

Superior mesenteric venous thrombosis is a rare & life threatening condition. We report a case of 18 years old boy presented to emergency department with pain abdomen, fever, Melena for almost week duration. Bowel sounds were absent since two days. With a preoperative diagnosis of peritonitis Patient was taken up for emergency laparotomy. Resection of gangrenous small bowel and end to end anastomosis was done. Intra operatively thrombus in SMV was found. Coagulation profile was normal except for elevated homocystine levels. Early postoperative period was stormy. Patient was started on LMV Heparin from day -1. Pregangrenous changes were seen in contrast CT abdomen on Day-4. We managed conservatively with anticoagulation therapy in the postoperative period. Pregangrenous changes disappeared with conservative management. Patient was shifted to oral warfarin and discharged on 3rd week. Follow up Doppler USG abdomen revealed a portal vein of normal size & caliber with no evidence of thrombus. On postoperative follow up for one year, patient is doing well. Hyperhomocycteinemia is an independent predisposing factor to superior mesenteric venous thrombus.