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A 4-year-old boy was evaluated for recurrent abdominal pain and failure to thrive over a 1-year period in a pediatric subspecialty clinic. Results of the extensive workup mostly were unremarkable. Eventually, imaging studies of the abdominal aorta revealed an isolated thrombosis of the superior mesenteric artery trunk and compensatory hypertrophy of the inferior mesenteric artery. He had been having abdominal angina symptoms and fear of eating. A detailed family history suggested a possible hypercoagulable state. However, an extensive hematologic evaluation did not reveal a recognizable defect that could produce thrombotic events. He was treated by arterial graft bypass surgery and started on conventional anticoagulants. Several months later, he developed repeat, near-total thrombosis of the graft with recurrence of his symptoms. After balloon dilation of the graft and starting him on appropriate anticoagulant maintenance regimen, he had good symptom relief, and the graft remained patent. This presentation was unusually prolonged for the type of vascular problem identified. The possibility of vascular problems in children, therefore, should be considered. Unidentified cause of hereditary clotting tendency is another challenging aspect of this case.