29 yr old male with Mesenteric venous thrombosis with polyserositis with bowel involvement | Further Plan?

No previously known comorbidities, presented elsewhere with loose stools large bowel type, 3-6 episodes per day associated with blood for initial 10 days, intermittent diffuse post prandial pain abdomen, abdominal distension, esayfatigability, loss of appetite and weight (16 kg) since past 2 months

• On evaluation

• Hb– 6.9, TLC – 8740, Plt 5lakhs

• LFT – Normal Alb 3.4, TSH 1.89

• UGIE – Grade B esophagitis

• Colonoscopy (15/9/20) diffuse involvement of mucosa with loss of vascularity, granularity, friability and diffuse ulcerations from rectum to mid transverse colon

• Biopsy – Cryptitis, Crypt abscess with dense inflammatory infiltrate in lamina propria

CECT Abd (13/10/20)

• Diffuse edematous wall thickening of entire large bowel

• Sub acute near complete thrombosis of SMV, thrombosis of left branch of PV, distal MPV and SMV, complete thrombosis of right hepatic vein, perfusion abnormalities in SegV of liver, no ascites

• Managed with warfarin, diuretics, mesalamine, 2 units PRBC

CECT Abd (27/10/20)circumferential mural thickening involving large bowel and rectum with mild adjacent fat stranding, thrombosis of left branch of PV, distal MPV and SMV, moderate ascites, bilateral minimal pleural effusion

EVALUATION

• CBP – Hb 9.1, MCV 90, TLC 4400, Plt – 1.2 lakhs

• LFT/RFT – WNL except for severe Hypoalbuminemia (TP/Alb – 4.6/1.6) and Hypokalemia

• Lactate – 0.9, LDH - 366

• 2D ECHO – Normal study

• CECT Abdomen (21/11/20) – perfusion abnormalities in liver, diffuse mural thickening in proximal colon, transverse, descending colon and proximal sigmoid colon, thrombosis of MPV extending into left branch of PV and its tributaries, splenoprtalconfluence and proximal splenic vein, SMV showed partial recanalization, moderate ascites