Acute intestinal ischaemia from a portal vein thrombosis in a young female smoker on an oral contraceptive

Abstract

We report the case of a 23-year-old woman who presented with bloody diarrhoea and multiple syncopal events. While the initial diagnosis clinically appeared to be inflammatory bowel disease, she was found to have a portal vein thrombosis (PVT) on MR cholangiopancreatography and acute intestinal ischaemia on colonic biopsy. The aetiology of this patient's PVT is attributed to her acquired prothrombotic state from an estrogen-containing contraceptive pill in conjunction with regular tobacco use. Extensive mesenteric venous thrombosis from an acute PVT has been shown to cause intestinal ischaemia, likely from venous obstruction and reflexive arterial constriction; however, the diagnosis is often delayed until surgery or autopsy. Our case report highlights this patient's clinical presentation, workup and treatment, as part of a review for the risk factors and guidelines recommendations for management of an acute PVT.

Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis: A case report

“…Common causes of splanchnic vein thrombosis include underlying malignancy, cirrhosis, pancreatitis, and postoperative complications[ 3 , 4 ]. However, there are also reports that prothrombotic disease and oral contraceptives can cause portomesenteric venous thrombosis[ 5 , 6 ]. The etiology of MVT in 75% of patients can be identified, with MVT induced by oral contraceptives accounting for 4%–5% of all MVTs and for 9%–18% in young women[ 7 ].…”

Mesenteric and portal vein thrombosis, a rare complication in a patient with polycystic ovary syndrome: A case report and review of literature

“…Five additional cases of OCP-associated intestinal ischemia related to mesenteric vein thrombosis were noted in the review of more recent published data [ [11] , [12] , [13] , [14] , [15] ]. Two of these cases did respond well to conservative treatment with heparin [ 9 , 15 ], while four patients required laparotomy [ [11] , [12] , [13] , [14] ], and three required segmental bowel resections [ [11] , [12] , [13] , 15 ]. In Table 1 , the majority of patients had similar presentations of abrupt onset abdominal pain, with two of them also presenting with bloody diarrhea, and were all diagnosed after 10 days and treated with antibiotics first.…”

Sigmoid Colon Varices due to Massive Thrombosis of a Noncirrhotic Extrahepatic Portosystemic Shunt

“…A slow blood flow is a risk factor for PVT ( 16 ) and it may lead to an impaired thrombin breakdown ( 17 ). Acute symptomatic PVT requires urgent management, and treatment failure can result in mesenteric ischemia ( 18 , 19 ). Several anticoagulant agents are used to treat PVT in cirrhotic patients.…”