Is conservative management safe for mesenteric venous ischemia? Two case reports

Abstract Acute venous mesenteric ischemia (AVMI) caused by porto-mesenteric thrombosis, is a rare yet life-threatening condition with nonspecific symptoms. It necessitates high clinical suspicion for timely diagnosis. Enhanced computed tomography (E-CT) is the gold standard for diagnosis. Unlike arterial mesenteric ischemia, which requires immediate surgical or interventional radiology interventions, AVMI can be managed conservatively with anticoagulation, antibiotics, and bowel rest, although close monitoring is essential. This report presents two cases of AVMI affecting the small bowel, attributed to extensive porto-mesenteric thrombosis and managed non-surgically initially. One patient later required bowel resection following delayed perforation. AVMI is an often underrecognized diagnosis, making early recognition vital for initiating prompt treatment. While radiological assessments may initially raise concerns and suggest small bowel necrosis, conservative management can be employed to prevent intestinal infarction and perforation and the need for surgical intervention. Nonetheless, follow-up is necessary. Unfortunately, late perforation can occur and must be recognized immediately.