Mesenteric venous thrombosis as a complication of appendicitis in an adolescent: A case report and literature review

Abstract

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 pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix.

Diagnoses: Mesenteric venous thrombosis complicating acute appendicitis.

Interventions: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy OUTCOMES:: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis.

Lessons: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.

Figure 1

Computed tomography scan demonstrated a focal thrombotic occlusion of the superior mesenteric branch without associated bowel change (A)(B) (see arrow).

Figure 2

Focal fluid distension at the appendix tip and aeration at the proximal portion of the appendix (see arrow).