COMPUTED-TOMOGRAPHY OF SUPERIOR MESENTERIC VEIN-THROMBOSIS FOLLOWING APPENDECTOMY

During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after a n appendectomy. No sign of SMV was present at appendectomy, and a peri od of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, t he appendicitis was complicated. These patients had nonspecific: signs and symptoms, although two of them; had elevation of blood hepatic en zyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an in traluminal clot. In one case, CT showed extension of the thrombus to:t he portal vein with the presence of low-attenuation areas in the liver , consistent with hepatic infarcts. Two patients had predisposing dise ases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicit is, and early appendectomy in appendicitis can prevent this complicati on. Moreover, as in any abdominal surgery, early appendectomy may be c omplicated by thrombosis of the SMV, thus creating problems of postope rative diagnosis. The complication is more frequent when the initial o peration is performed under difficult conditions (peritonitis), or whe n the patient presents with a coagulopathy. CT is useful in the diagno sis of SMV thrombosis, thus leading to early management with anticoagu lant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction.