A Case of Acute Mesenteric Venous Thrombosis in a Patient with Ulcerative Colitis and Positive Antiphospholipid Antibodies That Was Successfully Treated with Two-Stage Total Proctocolectomy

Abstract

The patient in this case was a 37-year-old male diagnosed with cerebral venous thrombosis and ulcerative colitis in January 2020. Treatment began with warfarin potassium, mesalazine, and adalimumab. In an examination in our internal medicine department in April of the same year, the patient tested positive for anti-phosphatidylserine-dependent antiprothrombin antibodies, raising suspicion of concurrent antiphospholipid syndrome, but a definitive diagnosis could not be confirmed. In August 2021, he developed lower abdominal pain, and a CT scan suggested necrosis of the sigmoid colon. Emergency surgery was performed on the same day, revealing a dark red, swollen sigmoid colon. This was determined to be due to necrosis caused by congestion from a thrombus in the sigmoid mesenteric vein. Scattered signs of congestion were also observed in the small intestine, and disseminated intravascular coagulation had developed, prompting the decision to forego single-stage resection. Instead, total colectomy and creation of an ileostomy were performed, followed by a secondary transanal mesorectal excision in March 2022. Since the initial surgery, there has been no recurrence of intestinal necrosis, but anticoagulant therapy has been continued due to suspected thrombophilia.