Superior Mesenteric and Portal Vein Thrombosis Caused by Congenital Antithrombin III Deficiency: Report of a Case

Abstract

A 50-year-old man presented with a 24-h history of gradually worsening abdominal pain. Enhanced computed tomography showed segmental dilation of the small intestine, wall thickening, and ascites, as well as thrombosis of the superior mesenteric vein (SMV) and portal vein. Thus, an emergency laparotomy was performed, which revealed segmental intestinal infarction caused by the thrombosis in the SMV and portal vein. We resected the necrosed intestine and performed anastomosis. The patient was given intravenous heparin and nafamostat mesilate as anticoagulation therapy. The abdominal pain again recurred 4 days after this operation, necessitating a second laparotomy. Segmental congestion of the intestine was found and another resection was done, after which he recovered rapidly. Blood chemistry subsequently revealed an antithrombin III deficiency, which was confirmed to be inherent, after screening his family. Thus, laboratory testing for these proteins may help define the cause of mesenteric venous thrombosis.

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

“…When thrombosis occurs only in the portal vein, clinical symptoms such as abdominal pain, nausea, anorexia, and weight loss are usually not serious. When thrombosis involves the superior mesenteric vein, patients may have cramps in the upper middle or lower middle abdomen, nausea, anorexia, vomiting, diarrhea, and/or bloody stool [2][3][4] . Conservative medical treatment is often unsatisfactory.…”

Douleurs abdominales atypiques au premier trimestre de la grossesse

“…Un auteur a rapporté un cas d'infarctus veineux mésentérique survenu dans le post-partum chez une jeune femme prenant des contraceptifs oraux de type estroprogestatif [6]. Enfin, quelques cas de thromboses veineuses portale et mésentérique supérieure en dehors de la grossesse ont été décrits [7][8][9].…”

“…Que la thrombose survienne pendant la grossesse ou non, les signes cliniques sont généralement bruyants mais peu spécifiques : il s'agit de douleurs intenses localisées dans l'épigastre, le flanc ou l'hypochondre droit accompagnées de nausées et parfois de vomissements [3,4,6,8,9]. Certains patients avaient une symptomatologie plus atypique avec une masse abdominale [10] ou étaient totalement asymptomatiques [2].…”

“…Le diagnostic est porté par une échographie doppler qui montre un thrombus et une veine porte extrahépatique distendue par le thrombus [2,3]. Celui-ci s'étend fréquemment à la veine splénique et à la veine mésentérique supérieure [4,[8][9][10].…”

Antithrombin deficiency and its laboratory diagnosis

“…DVT not infrequently develops at unusual sites, such as in the proximal extremities, and in mesenteric, renal, portal, retinal and cerebral veins (67)(68)(69)(70). Intracardial atrial thrombosis has also been reported (71).…”