Management of acute portomesenteric venous thrombosis induced by protein S deficiency: Report of a case
Journal
Surgery Today
Journal Volume
42
Journal Issue
10
Pages
1014-1018
Date Issued
2012
Author(s)
Abstract
Hereditary protein S deficiency is a risk factor which may predispose patients to venous thrombosis. Deep venous thrombosis of the lower extremities can result in painful congestion, while the presence of mesenteric venous thrombosis (MVT) can cause abdominal emergencies. We herein report a protein S-deficient patient presenting with acute portomesenteric venous thrombosis. Early management using anticoagulant therapy was initially successful. However, the subsequent bowel stricture resulting from the ischemic insult was further managed with a surgical bypass. The patient was kept on long-term thrombophylaxis. The treatment strategy for MVT with bowel ischemia has evolved from aggressive portomesenteric thrombectomy with resection of the involved bowel, to conservative anticoagulation to recanalize thrombotic mesenteric veins with bowel preservation. Surgical intervention is reserved for transmural necrosis or bowel perforation. The perioperative thrombophylaxis of inherited thrombophilic patients is also important for preventing further thromboembolic events. ? Springer 2012.
Other Subjects
anticoagulant agent; enoxaparin; warfarin; acute disease; adult; anticoagulant therapy; article; bypass surgery; case report; drug substitution; drug withdrawal; early intervention; human; intestine ischemia; intestine perforation; intestine resection; intestine stenosis; male; mesenteric vein thrombosis; perioperative period; portal vein thrombosis; protein S deficiency; recanalization; thrombectomy; thromboembolism; thrombophilia; thrombosis prevention; Acute Disease; Adult; Anticoagulants; Humans; Jejunum; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Portal Vein; Protein S Deficiency; Venous Thrombosis
Type
journal article