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

Abstract

Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors.

Acute Mesenteric Venous Thrombosis Induced by Smoking

“…The microscopic features of MVT include hyperemia, hemorrhage, and edema of the intestinal wall. In addition, hemorrahagic infarctions may occur due to occlusion of intramural vessels [2,11]. In our case, the patient suffered from peritonitis and underwent an emergency laparotomy without preoperative CT scan.…”

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

“…Врачам всех специальностей необходимо помнить о том, что при беременности имеет место повышенная активность свертывающей системы крови и вероятность развития венозных тромбозов, в том числе атипичных локализаций, повышается. В настоящее время развитие медицинских технологий позволяет диагностировать такую редкую форму аномалии строения магистральной вены на ранних этапах и, применяя современные методы лечения, даже сохранять беременность [5,6,8,9].…”

“…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]. Аномалии развития нижней полой вены встречаются в 0,2-3% наблюдений и чаще являются случайной патологоанатомической, операционной находкой или обнаруживаются современными высокоточными методами исследования [10,11].…”

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.…”