A Rare Case of Superior Mesenteric Artery Thrombosis With Gangrenous Bowel in a Patient With Mitral Valve Replacement in a Hypocoagulable State

Acute thromboembolism of the superior mesenteric artery (SMA) causing mesenteric ischemia has a grave prognosis with high mortality rates. Its rarity and non-specific symptoms often lead to delayed diagnosis and increased morbidity. Early signs can include pain out of proportion to physical findings, with abdominal distension, tenderness, and guarding appearing only in later stages when bowel necrosis has occurred. Leukocytosis, metabolic acidosis, and lactic acidosis may also be present. Immediate treatment through radiological investigation and restoration of blood flow can be through interventional radiology or surgery. In cases of infarction, resection and exteriorization are needed. Patients with mechanical mitral valves, even on blood thinners, remain at risk for thromboembolism and may benefit from novel oral anticoagulants requiring less frequent monitoring. Regular monitoring of prothrombin time and international normalized ratio (INR) is essential for those on warfarin, as drugs and dietary changes (eating green leafy vegetables) can significantly affect INR levels. Early suspicion and prompt treatment are vital for improving outcomes.