SHM Converge Scientific Abstract ePoster Gallery-Significant Bowel Necrosis From Venous Thrombosis Presenting With Unremarkable Lactate

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A 52-year-old man with hypertension, sleep apnea, and polycythemia presented with 2 weeks of abdominal bloating, pain, and vomiting. On exam, his abdomen was only mildly distended and nontender. Initial labs showed marked leukocytosis and elevated liver enzymes and bilirubin, but his lipase and lactate were normal. Early CT imaging suggested enteritis, ileus, or partial obstruction.<br /><br />A repeat CT later revealed portal venous thrombosis extending into the superior mesenteric vein and small bowel mesentery. He was treated with broad-spectrum antibiotics, heparin, and bowel decompression. Because his lactate remained normal and his abdominal exam was relatively benign, surgery initially recommended conservative management, delaying intervention for nearly 10 days despite persistent symptoms.<br /><br />As his condition worsened, he developed fever, a WBC of 37,000/µL, rising bilirubin, and ongoing abdominal soreness, yet lactate was still unremarkable. A repeat CT angiogram was largely unchanged. He then underwent laparoscopic surgery converted to open laparotomy, which revealed 50 cm of ischemic small bowel and a hyperemic, thrombosed mesentery. A 95 cm segment was resected. Pathology showed acute ischemic enteritis with ulceration and transmural necrosis.<br /><br />This case highlights that significant bowel necrosis can occur despite normal lactate and minimal abdominal tenderness, especially in venous thrombosis where ischemia may evolve more slowly and collateral circulation may delay typical lab abnormalities. It emphasizes that a normal lactate does not exclude mesenteric ischemia or bowel infarction and should not prevent timely surgical evaluation when clinical suspicion remains high.

Asset Subtitle

Gina Ma

Meta Tag

Author List Gina Ma, Xiaomei Meng

Category Clinical Vignettes

Concept Intestinal Ischemia

Concept Bowel Necrosis

Concept Mesenteric Ischemia

Concept Bowel Infarction

Concept Lactate Level

Distinguished Non-Finalist

Presenter Organization Ohio State University Medical Center

Presenting Author Gina Ma

Track Adult

Keywords

mesenteric ischemia

portal venous thrombosis

superior mesenteric vein

small bowel necrosis

bowel infarction

normal lactate

abdominal pain

ischemic enteritis

laparotomy

transmural necrosis

Intestinal Ischemia

Bowel Necrosis

Mesenteric Ischemia

Bowel Infarction

Lactate Level