We present a patient who had a 3-day history of epigastric pain and acid regurgitation and was found to have gastroesophageal reflux disease and duodenitis by esophagogastroduodenoscopy. His symptoms were refractory to treatment with a proton pump inhibitor. Peritonitis developed subsequently. Enhanced computed tomography (CT) confirmed a diagnosis of mesenteric venous thrombosis (MVT) with jejunum infarction. Emergency exploratory laparotomy with segmental resectioning of the jejunum was performed. We emphasize that emergency department (ED) physicians should always thoroughly re-evaluate patients with abdominal pain using serial physical examinations in accordance with the chronic nature of the disease. There is a need to be highly alert to pain that is out of the proportion to the physical examination results and/or endoscopic findings, the development of peritoneal irritation signs, the presence of fever, and the presence of leukocytosis among patients with nonspecific endoscopic findings. This will help to differentiate MVT as the true etiology of ischemic duodenitis in a timely manner. ED physicians should also be aware that hyperemic edematous duodenitis can be the finding for MVT using endoscopy.
- Mesenteric venous thrombosis
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Emergency Medicine