J Surg, an open access journal ISSN: 2575-9760 1 Volume 05; Issue 09 Journal of Surgery Case Report García-Ávila AK, et al. J Surg 5: 1324. Jejunal Stenosis as a Late Complication of Superior Mesenteric Vein Thrombosis: Overview and Case Report Ana Karen García-Ávila * , Luis Eduardo Casasola-Sánchez, Karina Sánchez-Reyes and Patricio Sánchez-Fernández Department of General Surgery, Specialty Hospital, XXI Century National Medical Center, Mexico * Corresponding author: Ana Karen García-Ávila, Department of General Surgery, Specialty Hospital, XXI Century National Medical Center, Av. Cuauhtémoc 330, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico Citation: García-Ávila AK, Casasola-Sánchez LE, Sánchez-Reyes K, Sánchez-Fernández P (2020) Jejunal Stenosis as a Late Com- plication of Superior Mesenteric Vein Thrombosis: Overview and Case Report. J Surg 5: 1324. DOI: 10.29011/2575-9760.001324 Received Date: 30 July, 2020; Accepted Date: 07 August, 2020; Published Date: 11 August, 2020 DOI: 10.29011/2575-9760.001324 Abstract Ischemic bowel stenosis is an infrequent late complication of chronic ischemia in a patient with thrombosis of the Supe- rior Mesenteric (SMV) and portal vein (PV) and there are only few cases reported. Abdominal Computed Tomography scan (CT scan) is the preferred radiologic test for this disease. Close follow-up of each patient is essential even after treatment for MSV thrombosis for an early diagnosis and treatment of this complication. We present a case of ischemic jejunal stenosis sub- sequent to SMV thrombosis and anticoagulant treatment, as well as a literature overview Keywords: Bowel ischemia; Jejunal stricture; Superior mesenteric vein thrombosis Introduction Mesenteric ischemia refers to intestinal hypoperfusion which can be due to occlusive obstruction of the venous mesenteric outfow, it can be classifed as acute, sub-acute or late ischemia due to time of onset [1]. Acute thrombotic occlusion of one or more mesenteric veins reduce the perfusion pressure due to the increased resistance in the mesenteric venous bed. As stasis begins, venous pressure increases leading to fuid overfow toward tissues, causing intestinal wall edema, which can produce submucosal bleeding. If the venous arches and the rectal vessels are involved and the venous fow is completely occluded, it will cause intestinal infarction or, if it reperfuses, an ischemic estenosis stenosis[2]. . Small bowel stenosis due to ischemia is a late complication in patients with thrombosis of the Superior Mesenteric Vein (SMV) and/or the Portal Vein (PV) [3,4]. Post ischemic stenosis can present as a segmental circumferential ulcer and tubular segmental stenosis [5]. Abdominal Computed Tomography (CT) is the standard diagnostic method for the initial assessment as well as for determining location, possible etiology and extent of the pathology. We report a case of ischemic proximal jejunal stenosis in a patient with history of SMV thrombosis due to Oral Contraceptives (OC) and management with Oral Anticoagulant (OA), as well as a literature review. Case Report A 49 year old female attended the emergency department with vague abdominal pain of three weeks duration, progressive oral intolerance and abdominal distention. Examination revealed abdominal distention with palpable bowel loops, diffuse abdominal tenderness and normal digital rectal examination. Her past medical history included SMV thrombosis one month previously (Figure 1) currently under OA therapy with a factor Xa inhibitor. She had history of OC chronic intake. On admission a nasogastric tube was placed, obtaining abundant high intestinal output with later symptoms improvement. Biochemical studies revealed no alterations, leucocytes count of 5,200 /µL. High outlet obstruction syndrome was diagnosed and a small intestine follow through was performed, which revealed an increased diameter at the proximal jejunum, up to 52 mm, and a subsequent transition zone (Figure 2A). Due to her medical history of thrombosis an abdominal CT angiography was performed which showed signifcant stomach dilatation as well as the duodenum and proximal jejunum with a transition zone at the present site (Figure 2B) features of mechanical small bowel obstruction. The previously thrombus in the SMV had resolved. Enteroscopy was also performed and revealed a signifcant decrease in jejunal caliber, 40 to 50 cm after Treitz angle, due to stenosis presented with ulcerated edges covered with fbrin, impassable, with 3mm diameter, a tissue simple was taken (Figure 3). Based on the previous fndings, surgical team decided to perform an exploratory laparotomy where a stenosis was found at 50 cm of Treitz angle of approximately 70 mm that conditioned