A Rare Case of Superior Mesenteric Artery Thrombosis Post Vaginal Delivery

Abstract Introduction: Acute abdominal pain following a vaginal delivery is rare. Various causes of severe acute postpartum abdominal pain include, pelvic infection, thrombophlebitis, ovarian venous thrombosis, acute urinary retention. Mesenteric vessel thrombosis is an uncommon but often fatal form of intestinal ischemia. Case presentation: Our case describes a 35 years old grand multipara presented three weeks after spontaneous vaginal delivery with severe abdominal pain, abdominal distension, and hematemesis of acute onset. No significant medical history. Past surgical history of bariatric surgery two years back. The patient’s hemodynamic state was unstable and was diagnosed with superior mesenteric artery thrombosis by contrast-enhanced computed tomography and had urgent laparotomy and resection of the bowel segment with the temporary closure of the abdomen. On the next day a second look laparotomy was done later reversal of Roux en Y gastric bypass (gastro-gastric anastomosis, jejuno-jejunal anastomosis, and jejuno-ileal anastomosis), appendectomy was carried out. She was discharged on the 10th day of admission in stable condition with regular follow-up in the surgical outpatient department. Conclusion: Even after vaginal birth, pregnancy and puerperium raise the risk of thrombosis. Given that this is frequently discovered at a late and irreversible stage, an increased index of suspicion is required for an early diagnosis and rapid therapy to enhance the maternal prognosis. To lower maternal mortality, risk assessments for thromboembolism must be made periodically. To rule out mesenteric artery ischemia in cases of acute abdominal discomfort, abdominal contrast-enhanced computed tomography may be required.