Acute mesenteric venous thrombosis due to protein S deficiency in a pregnant woman

Abstract

Acute mesenteric venous thrombosis is a rare and potentially fatal disease, which often occurs in medically compromised elderly patients. Isolated mesenteric venous thrombosis may be encountered in young women who have underlying hypercoagulable disease. We report a case of mesenteric venous thrombosis in a young pregnant woman in whom protein S deficiency was diagnosed at a later stage. The patient underwent extensive bowel resection. On follow-up she had developed an obstruction on the intestinal anastomosis. The anastomosis was revised, but the patient died of intervening complications 3 months after the operation. Early management of acute mesenteric venous thrombosis relies on early diagnosis, which requires a high index of suspicion. The condition must be considered during evaluation of persistent abdominal pain in pregnant women with hypercoagulable disorder.

Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman

“…Precipitating factors associated with MVT may include portal hypertension, postoperative state, trauma, neoplasm, inflammatory bowel diseases, use of estrogen-containing compounds, polycythemia vera, hemoglobinopathies, and hypercoagulable states resulting from protein S, protein C, and antithrombin III deficiencies [17]. Through the literature review, additional precipitating factors could be identified in 8 of the 9 pregnant women with small bowel ischemia due to superior MVT: 2 had mistakenly used oral pills during pregnancy [8, 9], 2 had known history of hypercoagulopathies [10, 11], 1 developed MVT soon after elective cesarean section [12], 1 had CMV infection complicated further by toxic megacolon [13], 1 had history of chronic idiopathic MVT [14], and 1 had hemoglobinopathy [15]. Only one case in the literature and our case possess no precipitating factor to develop MVT [16].…”

Pregnancy and Vascular Liver Disease

“…In the largest recent series, 0-4% of PVT cases were time-related to pregnancy. [36][37][38][39][40][41] Thrombosis risk factors have been reported in some cases of PVT revealed by pregnancy, namely protein S deficiency, [42][43][44] but not in others [45][46][47][48] Here again, results of investigation for underlying MPD are seldom mentioned, raising the hypothesis that some cases may have been misdiagnosed as idiopathic, as around 30% of non-cirrhotic PVT occurs in MPD patients. 49 Altogether, these data suggest that pregnancy alone is not a clear risk factor for PVT.…”

“…Although the risk of miscarriage and premature birth is heightened, current management of these diseases makes it very likely to see the birth of a live baby when pregnancy reaches 20 weeks of gestation. ( J CLIN EXP HEPATOL 2015;5: [41][42][43][44][45][46][47][48][49][50] V ascular disorders of the liver include a spectrum of conditions involving the portal venous system, the intrahepatic vessels, the hepatic veins and the terminal portion of the inferior vena cava. Although rare, they frequently affect women of childbearing age.…”

Acute mesenteric venous thrombosis in pregnant women with thrombophilia and doubled inferior vena cava

“…[1]. По данным современных авторов, частота подобного заболевания в общей популяции составляет менее 0,1%, среди всей острой мезентериальной ишемии на его долю приходится 6,2-15% [1][2][3][4]. У беременных женщин случаи тромбоза вен портальной системы являются еще более редкой клинической находкой, описываются в литературе в качестве единичных наблюдений.…”

“…У беременных женщин случаи тромбоза вен портальной системы являются еще более редкой клинической находкой, описываются в литературе в качестве единичных наблюдений. По мнению одних авторов, в этиологии этого осложнения имеют значение различные тромбофилии [3,5,6]. Другие исследователи описывают идиопатический мезентериальный венозный тромбоз на фоне протекающей беременности [2,4,[7][8][9].…”