A Case Report of Superior Mesenteric Vein Thrombosis after Right Hemicolectomy for Ascending Colonic Diverticulitis Successfully Treated with Conservative Therapy

Takahito Saiki, Tsuyoshi Matsuno, Toshihito Inokuchi, Kenji Hujisawa and Akihiko Kaihara

Department of Surgery, Saiseikai Imabari Hospital

A 40-year-old man undergoing right hemicolectomy for repeated ascending colonic diverticulitis and discharged on postoperative day 21 reported slight wound pain, but no abnormality in physical examination and on laboratory data was seen, so he was prescribed painkillers. On day 18 after discharge, he was admitted for severe upper abdominal pain. Contrast-enhanced CT showed dilation of the superior mesenteric vein (SMV) and radiolucency in SMV under confluence of splenic vein, suggesting SMV thrombosis. Conservative therapy with continuous intravenous heparin administration was initiated because of no signs of intestinal necrosis. Abdominal findings indicated slight improvement and the thrombus contracted within 13 days of treatment as seen in CT. Intravenous heparin administration was replaced by warfarin potassium. Three months after therapy, CT showed further contraction of the thrombus and reflow in the SMV. Because the blood coagulation studies showed no abnormalities and portal hypertention was not observed, SMV thrombosis in this case was thought to have been induced by right hemicolectomy.

Key words
SMV thrombosis, anticoagulant therapy, colectomy

Reprint requests
Takahito Saiki Department of Surgery, Saiseikai Imabari Hospital
7-1-6 Kitamura, Imabari, 799-1592 JAPAN

Accepted
February 20, 2008

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