SHM Converge Scientific Abstract ePoster Gallery-Thrombophilia in Crohn's Disease : Case of Mesenteric Venous Thrombosis

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This case report describes a 55-year-old patient with Crohn’s disease, prior small bowel resection, and recent switch from infliximab to upadacitinib who presented with fever, diarrhea, and worsening abdominal pain. Initial CT imaging showed terminal ileitis consistent with active Crohn’s disease, and blood cultures grew multiple organisms, including Klebsiella pneumoniae, Citrobacter freundii, Clostridium perfringens, and Fusobacterium species. Despite treatment with broad-spectrum antibiotics, the patient’s abdominal pain persisted. Repeat CT then revealed portal vein thrombosis and new thrombi in branches of the distal ileal superior mesenteric vein, confirming mesenteric venous thrombosis.<br /><br />Hematology recommended anticoagulation and hypercoagulable testing, while colorectal surgery advised medical management because there were no peritoneal signs. Workup identified lupus anticoagulant, anticardiolipin IgM, and beta-2 glycoprotein antibodies, suggesting antiphospholipid syndrome as an underlying thrombophilic condition. Endoscopy also showed nonbleeding duodenal ulcers. The patient improved clinically and was discharged on six weeks of IV antibiotics, budesonide for Crohn’s disease, and lifelong anticoagulation.<br /><br />The discussion emphasizes that mesenteric venous thrombosis is rare but often associated with hypercoagulable states and inflammatory bowel disease. Crohn’s disease is linked to increased antiphospholipid and other procoagulant antibodies. Contrast-enhanced CT, especially portal venous phase imaging, is key for diagnosis. Early anticoagulation is recommended when there are no peritoneal signs, while surgical consultation is needed if bowel ischemia or peritonitis is suspected. The authors conclude that clinicians should maintain a high index of suspicion for mesenteric vein thrombosis in Crohn’s patients, particularly those on upadacitinib, because delayed diagnosis can lead to bowel ischemia, high mortality, and poor outcomes.

Asset Subtitle

Sandhya Tagaram

Meta Tag

Author List Sandhya Tagaram, Shashidhar Reddy Madireddy

Category Clinical Vignettes

Concept Mesenteric Venous Thrombosis

Concept Anticoagulation

Concept Crohn Disease

Concept Contrast-Enhanced Computed Tomography

Concept Abdominal Pain

Distinguished Non-Finalist

Presenter Organization UMass Memorial Medical Center, Worcester, MA

Presenting Author Sandhya Tagaram

Track Adult

Keywords

Crohn’s disease

mesenteric venous thrombosis

portal vein thrombosis

superior mesenteric vein

antiphospholipid syndrome

upadacitinib

terminal ileitis

hypercoagulable state

contrast-enhanced CT

anticoagulation

Mesenteric Venous Thrombosis

Anticoagulation

Crohn Disease

Contrast-Enhanced Computed Tomography

Abdominal Pain