A Case of Superior Mesenteric Venous Thrombosis Successfully Treated in Two-Stage Operation

We present a rare case of superior mesenteric venous thrombosis (SMVT) showing acute abdomen. A 22-year-old man admitted for severe abdominal pain was found in computerized tomography and angiography to have superior mesenteric venous thrombosis. Although anticoagulant therapy was started immediately, aggravated symptoms suggested intestine necrosis. Laparotomy 3 days after admission showed wide-ranging necrosis of the small intestine due to SMVT. About 170cm of the necrotic intestine was resected without anastomosis for fear of the risk of progression of SMVT which might result in necrosis of the remnant intestine. Reoperation 2 days after the first operation showed no necrosis in the remnant intestine. The stumps of the small intestine with the previous operation were anastomosed. The postoperative course was uneventful and he was discharged day 22 after the second operation. The combination of two-staged operation and anticoagulant therapy was successful in treating this patient with massive necrosis of the small intestine caused by SMVT.