Mesenteric Venous Thrombosis in a Patient with Pancreatitis and Protein C Deficiency

Abstract

Mesenteric vein thrombosis is an uncommon manifestation of hypercoagulable states. A case is reported of superior mesenteric vein (SMV) thrombosis in a patient with pancreatitis and protein C deficiency. A discussion of SMV thrombosis identification, management, and outcomes is included. The patient presented with a significant history of alcohol abuse and constant, midepigastric abdominal pain associated with nausea and vomiting. Amylase and lipase were elevated, and the patient was treated for pancreatitis. His symptoms initially responded to intravenous fluid hydration, but soon his clinical picture worsened, with increased nausea and vomiting, abdominal pain, and distension. Contrasted computed tomography of the abdomen revealed SMV thrombosis. A hypercoagulable workup revealed protein C deficiency. After a 3-month course of oral anticoagulant therapy, the SMV thrombosis resolved.

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

“…The application of surgical treatment is limited by tissue damage and additional complications [14][15][16][17] . With the development of interventional radiology, minimally invasive technology has become one of the predominant means of treating acute-subacute PV-SMV thrombosis without obvious intestinal necrosis, perforation, and peritonitis [18][19][20][21][22][23][24][25][26] . The method includes direct and indirect PV-SMV thrombolysis [27] .…”

Deep vein thrombosis associated with protein C and protein S deficiency: An unusual cause of acute abdomen

“…Contrast-enhanced abdominal CT scanning currently is the most commonly used alternative diagnostic test of choice with a sensitivity of greater than 90%; however, magnetic resonance venography has also been used in making the diagnosis. 9,10 In our case CT and vascular sonography were very successful to depict iliofemoral thrombosis.…”

“…Thus it is essential to repeat an assay after 4-6 weeks to confirm the deficiency. 7,9 In conclusion, this report underscores the fact that when acute abdominal pain in a child is encountered, deep venous thrombosis should be considered. Although this disease is not common, its recognition is important for appropriate evaluation and treatment in the emergency department.…”

“…7,8 Protein C-deficient patients have a significant risk of thrombotic event over the general population, up to a seven-fold increased risk. 9 We describe the case of a child with iliofemoral thrombosis due to protein C and protein S deficiencies mimicking acute abdomen.…”

Isolated Thrombosis of the Superior Mesenteric Vein

“…Mild cases are usually treated with conservative measures; severe cases may require admission to the intensive care unit, or even surgery, to deal with impending complications. Acute pancreatitis can result in many vascular problems, such as splanchnic vein thrombosis (splenic, portal, and/or superior mesenteric veins) and pseudoaneurysm [1][2]. Isolated thrombosis of the superior mesenteric vein (SMV) without involving the splenic or portal vein is very rare and is usually seen with intra-abdominal sepsis or pancreatic neoplasms [1].…”