Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2017; 9(10): 209-213
Published online Oct 27, 2017. doi: 10.4240/wjgs.v9.i10.209
Mesenteric vein thrombosis following impregnation via in vitro fertilization-embryo transfer
Masaaki Hirata, Hiroko Yano, Tomoe Taji, Yoshiharu Shirakata
Masaaki Hirata, Tomoe Taji, Yoshiharu Shirakata, Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
Hiroko Yano, Department of Obstetrics and Gynecology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
Author contributions: Hirata M, Yano H, Taji T and Shirakata Y contributed to writing and revising the manuscript.
Institutional review board statement: This study was reviewed and approved by the Hyogo Prefectural Amagasaki General Medical Center Institutional Review Board.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaaki Hirata, MD, Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo 660-0892, Japan. mhirata6341@gmail.com
Telephone: +81-6-64807000 Fax: +81-6-64807001
Received: May 30, 2017
Peer-review started: June 2, 2017
First decision: July 26, 2017
Revised: August 27, 2017
Accepted: September 5, 2017
Article in press: September 6, 2017
Published online: October 27, 2017
Processing time: 148 Days and 18.5 Hours
Abstract

Pregnancy is an acquired hypercoagulable state. Most patients with thrombosis that develops during pregnancy present with deep vein leg thrombosis and/or pulmonary embolism, whereas the development of mesenteric vein thrombosis (MVT) in pregnant patients is rare. We report a case of MVT in a 34-year-old woman who had achieved pregnancy via in vitro fertilization-embryo transfer (IVF-ET). At 7 wk of gestation, the patient was referred to us due to abdominal pain accompanied by vomiting and hematochezia, and she was diagnosed with superior MVT. Following resection of the gangrenous portion of the small intestine, anticoagulation therapy with unfractionated heparin and thrombolysis therapy via a catheter placed in the superior mesenteric artery were performed, and the patient underwent an artificial abortion. Oral estrogen had been administered for hormone replacement as part of the IVF-ET procedure, and additional precipitating factors related to thrombosis were not found. Pregnancy itself, in addition to the administered estrogen, may have caused MVT in this case. We believe that MVT should be included in the differential diagnosis of a pregnant patient who presents with an acute abdomen.

Keywords: Mesenteric vein thrombosis; Pregnancy; In vitro fertilization-embryo transfer; Oral estrogen

Core tip: Pregnancy is a hypercoagulable state that can lead to mesenteric vein thrombosis (MVT). Those symptoms are often nonspecific. Certain signs of MVT can be interpreted as normal changes during the progression of pregnancy; therefore, it is important to recognize the possibility of the development of MVT in the differential diagnosis of a pregnant patient with an acute abdomen. Estrogen can also cause thrombosis and is often administered for hormone replacement as part of an assisted reproductive technology (ART) procedure, particularly in vitro fertilization-embryo transfer. With further development of ART, the number of women taking oral estrogen during pregnancy may increase.