Abstract
A 63-year-old man was brought to our hospital complaining of abdominal pain and nausea. He had a history of deep vein thrombosis of the lower extremities 16 years earlier. Contrast-enhanced CT showed thrombus in the superior mesenteric vein (SMV) extending to the portal vein, along with ascites and thickening of the jejunal wall. Because intestinal blood flow was likely to be intact, systemic urokinase and heparin were immediately administered. Laboratory examination on admission revealed protein C antigen deficiency with protein C activity reduction. The patient was diagnosed with SMV thrombosis caused by protein C deficiency. Although he was treated on a ventilator temporarily due to acute respiratory distress syndrome, the patient recovered from respiratory failure with intensive anticoagulant therapy under careful monitoring. The patient was discharged from hospital on the 28th day after admission. He has been treated with oral warfarin as an outpatient without sign of recurrence. Immediate use of anticoagulants after diagnosis is likely to reduce the risk of surgical intervention and improve outcomes of SMV thrombosis.
