A Case of Mesenteric Abscess due to Penetration of Jejunal Diverticulum Comorbid Secondary Antiphospholipid Antibody Syndrome

Abstract

A 78-year-old woman, who had been receiving treatment for systemic lupus erythematosus and antiphospholipid syndrome (APS) in the Department of Internal Medicine in our hospital, presented with abdominal pain and diarrhea. Following close examination, she was diagnosed with small bowel mesenteric perforation and mesenteric abscess. Because of the increased risk of catastrophic APS due to infection, an urgent open partial resection of the small intestine and resection of the abscess were performed. The histopathological findings showed no evidence of microthrombi or emboli, and the cause was thought to be perforation of a small bowel diverticulum. Postoperatively, heparin was started early and switched to warfarin and cilostazol while monitoring coagulation, and the patient was transferred to the former department on postoperative day 14 without thrombotic or bleeding complications. Patients with APS are at the high risk of developing thrombosis and bleeding and require careful antithrombotic therapy, but perioperative appropriate antithrombotic therapy has not yet been established. In patients with APS secondary to infection requiring surgical treatment, early decision of surgery and careful perioperative antithrombotic therapy with monitoring are considered important to prevent catastrophic APS.