Abstract
We report an extremely rare case of protein C deficiency presenting as intestinal ischemia caused by superior mesenteric artery (SMA) and portal vein (PV) thrombosis while receiving medication. A 64-year-old man with a history of deep venous thrombosis and pulmonary infarction, and who had been taking warfarin potassium for protein C deficiency, complained of abdominal pain. Abdominal computed tomography showed the thrombosis of both the SMA and PV and ischemic change of the upper jejunum. An emergency operation was therefore performed. Macroscopic findings revealed congestion in the jejunum 20–80 cm distal to the ligament of Treitz’s and thrombi in the SMA and PV. We then conducted resection of the jejunum and jejunostomy. Serous protein C activity was decreased at 34%. The urokinase and heparin had been administered postoperatively as an anticoagulant therapy. When enteral nutrition was started, warfarin potassium was taken orally, instead of heparin. He underwent stoma closure at 74 days after the operation. At 34 months after surgery, the patient remains well without any evidence of recurrence.
