Passage of Gangrenous Small Bowel Per Rectum Following Superior Mesenteric Vessel Thrombosis
Aditya Prabhalkarrao Borgaonkar,
Department of Surgery, JNMC, DMIMS (DU), Sawangi Meghe, Wardha, Maharashtra, India.
Mesenteric venous thrombosis is a rare cause of chronic pain in abdomen. Only in few cases with abdominal pain, bowel infarct has been reported. This report is that of a 42-year-old male with a history of chronic alcoholism, presented with continuous dull pain in abdomen for 1 year and vomiting for 1 month, typically after ingestion of food. At the time of admission, his vitals were stable. On examination of abdomen, the only finding was tenderness in left hypochondriac and left lumbar region without guarding or rigidity. His erect abdomen radiograph suggested no evidence of intestinal perforation or obstruction. Ultrasonography of abdomen suggested bowel loops with normal peristalsis, no evidence of any dilatation or oedema of wall or of free fluid in peritoneal cavity. CT angiography of abdomen was suggestive of Superior Mesenteric Artery (SMA) thrombosis. While on conservative management he passed almost 2 feet small bowel per rectum. Emergency diagnostic laparoscopy showed faecal matter in left paracolic gutter. Exploratory laparotomy was done and jejuno-ileal resection and anastomosis were done.