Yudai Sasaki , Masahiro Yamada , Tomohide Hori * , Hidekazu Yamamoto , Hideki Harada , Michihiro Yamamoto , Takefumi Yazawa , Ben Sasaki , Masaki Tani , Asahi Sato , Hikotaro Katsura , Yasuyuki Kamada , Ryotaro Tani , Ryuhei Aoyama , Masazumi Zaima
22 January 2021
AII, acute intestinal infarction, PC, protein C, PCD, protein C deficiency, POD, postoperative day, PV, portal vein, SMV, superior mesenteric vein, SVT, splanchnic venous thrombosis, Deficiency, Portal vein, Protein C, Superior mesenteric vein, Thrombosis
Splanchnic venous thrombosis caused by superior mesenteric vein thrombosis is rare.
Delayed diagnosis and/or treatment can result in acute intestinal infarction.
Protein C deficiency is rare.
Insufficient awareness can result in mismanagement of splanchnic venous thrombosis.
Coagulation disorders contribute to acute intestinal infarction of unknown cause.
Splanchnic venous thrombosis (SVT) originating in the superior mesenteric vein (SMV) is rare and may cause acute intestinal infarction (AII). Protein C deficiency (PCD) results in thrombophilia.
Acute unexplained SVT originating in the SMV and portal vein was detected in 68-year-old man. Pan-peritonitis and AII were diagnosed and emergency surgery performed. Part of the small intestine was necrotic and partial resection without anastomotic reconstruction was performed. Heparin was administered intravenously continuously from postoperative day (POD) 1. Hereditary, heterozygous, type 1 PCD was diagnosed postoperatively. The anastomosis was reconstructed on POD 16. Warfarin was substituted for heparin on POD 22. No recurrent thrombosis occurred during 2 years of follow-up.
Patients with the rare condition of SVT require prompt diagnosis and treatment and may have underlying disease. PCD can cause SVT even in intact veins and anticoagulation therapy should be administered immediately postoperatively. Misdiagnosis and/or delayed treatment of SVT can result in AII, a life-threatening condition with a high mortality rate. Insufficient clinician awareness can result in serious mismanagement of patients with PCD and SVT; emergency patients with AII caused by unexplained SVT should therefore be further investigated for prothrombotic states and assessment of coagulation–fibrinolysis profiles to clarify the underlying mechanism.