IDDF2024-ABS-0340 Case series of acute porto mesenteric vessel thrombosis

<h3>Background</h3> We know that the viral infection-induced pro-coagulant state can cause acute mesenteric artery and portal vein thrombosis. These cases present to hospital emergency as acute abdomen, and timely aggressive management is the key to saving these cases. The purpose of this case series is to increase understanding of acute portomesenteric vessel thrombosis in Indian tertiary care centres. <h3>Methods</h3> Retrospective data review of portomesenteric vessel thrombosis cases from Western Indian tertiary care centre. <h3>Results</h3> In the first case, a 38-year-old male with a recent history of viral pneumonia was admitted with pain in the abdomen, vomiting, and constipation. WBC increased, D-Dimer 1950 ng/ml, CT angiography of the abdomen showing superior mesenteric vein thrombosis, dilated inflamed jejunal ileal bowel loops, started on LMW heparin supportive care, recovered in three days. The second case was a 62-year-old obese, diabetic hypertensive male with pneumonia in ICU on noninvasive respiratory support, developed pain in the abdomen, abdominal distension, and ileus. CECT abdomen revealed thrombosis of the superior mesenteric artery, D-dimer 2500 ng/ml. Injection Alteplase, injection. Enoxaparin therapeutic dose with supportive treatment continued. The patient recovered partially but later expired with cardiogenic shock and respiratory failure. The third case was a 28-year-old female with 20 20-day history of outpatient treatment for viral fever presented with acute abdomen, D-DImer 15ng/ml, CECT abdomen confirmed portal vein thrombosis. Managed with therapeutic Enoxaparin and supportive treatment, recovered in three days, and discharged on oral anticoagulants. The fourth case was a 37-year-old male with alcoholic liver disease admitted to the ICU with viral pneumonia, blue toe, and abdominal distension. Abdominal Doppler confirmed portal vein thrombosis, D-Dimer 9500ng/ml. Started on injection of Enoxaparin 1 mg/kg BID, antibiotics, injection methylprednisolone 40 mg BID, and supportive treatment improved well clinically, D-dimer decreased to 4000 ng/ml next day, recovered started on the oral feed but developed gross GI bleed, the dose of anticoagulant decreased, injection calcium started, developed sudden cardiogenic shock, bleeding continued, expired despite best ICU care. <h3>Conclusions</h3> Acute portomesenteric vein thrombosis is manageable with conservative care, but acute mesenteric artery thrombosis has a very poor prognosis.