Case Report: Acute superior mesenteric vein and portal vein thrombosis complicated by small intestinal necrosis: a case of successful endovascular treatment.

Background: Acute superior mesenteric vein thrombosis (ASMVT) and acute portal vein thrombosis (APVT) are rare conditions. In the absence of timely diagnosis and treatment, they can lead to intestinal congestion and necrosis, sepsis, and death. When intestinal necrosis is clinically suspected, emergency exploratory laparotomy is the standard of care and may necessitate resection of the necrotic intestine. Standard operating procedure (SOP) and guidelines remain lacking due to the rarity of this disease. Case Description: This article reports the case of a 44-year-old male patient who presented with acute abdominal pain and was diagnosed with acute complete thrombosis of the superior mesenteric vein and portal vein, with a clinical diagnosis of small intestinal congestion and necrosis. Emergency endovascular intervention was performed: percutaneous transhepatic portal venography, balloon dilation, thrombolysis and thrombectomy, and indwelling catheter thrombolysis. Postoperatively, the patient was transferred to the intensive care unit (ICU) for continued with catheter-directed thrombolysis (CDT) and anticoagulation therapy. Vascular recanalization occurred on postoperative day 9, and the patient was discharged after an uneventful recovery, thereby obviating the need for surgical intervention and bowel resection. Conclusion: For acute superior mesenteric vein and portal vein thrombosis complicated by intestinal congestion and necrosis, endovascular therapy combined with anticoagulation may be a treatment option prior to surgical intervention and warrants further investigation.