Twist of Fate: Life-Threatening SMA Thrombosis Caused by Mesenteric Torsion Post-Roux-en-Y Weight Loss

Superior mesenteric artery (SMA) thrombosis is rare yet critical illness that can result in lethal bowel ischemia and infarction. This report details a case of SMA thrombosis with associated superior mesenteric vein (SMV) narrowing, secondary to mesenteric torsion in a 26-year-old female with history of Roux-en-Y gastric bypass surgery. The patient's presenting symptoms were severe epigastric pain, vomiting, and significant anemia. Imaging confirmed SMA thrombosis with early signs of bowel ischemia. Interventional radiology promptly performed an SMA angiogram and initiated thrombolysis with a tenecteplase infusion, which led to near-complete resolution of the thrombus. This case draws attention to the necessity for early diagnosis and swift management of SMA thrombosis, particularly in post-surgical patients with altered gastrointestinal anatomy. The resolution of this case demonstrates the value of a collaborative care, combining interventional radiology and general surgery to prevent bowel ischemia.