Recurrent splanchnic venous thrombosis with mesenteric venous ischemia and secondary omental infarction after discontinuation of direct oral anticoagulation: A case report.

Splanchnic venous thrombosis (SVT) consists of thrombosis involving all or part of the portal, mesenteric, splenic, and related visceral veins. Noncirrhotic, nonmalignant SVT is uncommon, and decisions regarding duration of anticoagulation remain clinically challenging. We report a 66-year-old man with a history of a first episode of spleno-mesenteric venous thrombosis treated for 4 years with rivaroxaban. Eight years after the initial episode and 4 years following treatment discontinuation, he presented with severe diffuse abdominal pain. Contrast-enhanced abdominal computed tomography demonstrated recurrent partial thrombosis involving the porto-mesenteric venous axis with associated mesenteric venous ischemia and concomitant thrombosis of the left gastroepiploic vein complicated by infarction of the greater omentum. Therapeutic anticoagulation was resumed, and follow-up CT showed regression of portal thrombosis and improvement of ischemic findings, with imaging features consistent with collateral revascularization; however, a segmental infarction of the greater omentum persisted. An extensive thrombophilia and malignancy workup remained negative. This case highlights the imaging spectrum of recurrent SVT, including the uncommon association with secondary omental infarction, and supports consideration of long-term anticoagulation in apparently unprovoked SVT.