2019 Volume 39 Issue 1 Pages 033-037
A 72-year-old female patient presented to a nearby hospital with a 3-day history of abdominal pain and vomiting. Her medical history included surgery for lower left thigh varicosities. She was diagnosed as having bowel obstruction, and was referred to our hospital. Physical examination revealed rebound tenderness in the entire abdomen. Blood examination revealed elevated levels of the acute inflammatory markers and evidence of renal function impairment; the serum protein C concentration was 63％, while that of protein S was below 10％. Abdominal CT revealed a distended small intestine and a rise in concentration of a small mesentery. As strangulated bowel obstruction was suspected, an emergent operation was performed, and dark red massive ascites was observed intraoperatively. As about a 100-cm segment of the ileum had become necrotic, partial resection of the ileum was performed. During the operation, we detected a thrombus in the mesoileal vein. Based on these findings, the patient was diagnosed as having superior mesenteric vein thrombosis. Postoperatively, she was administered anticoagulant therapy. Although it was difficult to decrease the size of the thrombus, it lysed without re-operation. We present this case to highlight the elevated risk of occurrence of superior mesenteric vein thrombosis in association with protein C and S deficiency, which is otherwise rare, along with a review of literature.
