Superior mesenteric venous thrombophlebitis: A rare complication of a common disease

Abstract

We would like to report a case of acute appendicitis complicated with superior mesenteric venous (SMV) thrombophlebitis. A 61-year-old gentleman presented with abdominal pain and high fever with elevated white cell count and slightly deranged liver function and clotting profile. Besides features of acute appendicitis, a thrombus in superior mesenteric vein was demonstrated on computed tomography (CT). Patient was treated with emergency laparoscopic appendectomy, a course of antibiotics and subcutaneous enoxaparin. CT 2 months after operation showed features of resolving SMV thrombophlebitis. Mesenteric venous thrombophlebitis is difficult to diagnose as the clinical presentation is often nonspecific and it depends on the site and timing of thrombus formation. Such rare complication has to be suspected if the patient presents late or when there were high fever and deranged liver function. Prompt appendectomy and antibiotics therapy remain the essential components of treatment for acute appendicitis. The need of additional anticoagulation therapy and its optimal duration for SMV thrombophlebitis remains unclear. Nevertheless, the use of anticoagulation therapy should be weighed against the risk of bleeding complication.