Idiopathic Superior Mesenteric Vein Thrombosis Resulting in
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Small bowel ischemia is a relatively uncommon disorder; the primary causes are diverse and can be grouped into five major categories: strangulation, low-flow states (arrhythmia, sepsis, shock), embolus or thrombosis of superior mesenteric artery, superior mesenteric vein thrombosis (MVT), and
miscellaneous. Due to vague clinical presentation and the lack of specific diagnostic tests, early diagnosis for intestinal ischemia is difficult, resulting in significant morbidity and mortality. We herein report a case of a 31-year-old woman who was presented with the signs and symptoms of peritonitis at 34-week gestation. Surgical exploration revealed gangrene in the small intestine without mechanical obstruction. Hypercoagulable state is normally found in pregnant women, which was believed to result in superior MVT and then intestinal ischemia. To the best of our knowledge, this is the second report to describe such a rare disease developing during pregnancy, without evidence of other precipitating factors.

Case Report
At 34 weeks of gestation, a 31-year-old gravida 3 para 1 woman was referred to our emergency department from a local clinic owing to progressive epigastric pain associated with nausea and vomiting for 3 days. She had no significant medical or surgical history and no history suggestive of thromboembolism. She had never used any oral contraceptives or other hormonal preparations. Upon arrival, her vital signs were stable without fever (BP 120/78?mmHg, pulse rate 88/min, respiratory rate 19/min, and body temperature 37.1°C). The hematologic examination revealed marked leukocytosis (WBC 24,200/CMM) and relative intravascular depletion (hematocrit 44.5%). Coagulation profile and biological tests were within normal limits. Obstetric ultrasound showed a normal male fetus compatible with his gestational age. In addition, a mild fatty change in the liver and a moderate amount of ascites were also noted. The fetal monitor showed that the uterus contracts every 10 minutes....