Zhao JW, Cui XH, Zhao WY, Wang L, Xing L, Jiang XY, Gong X, Yu L. Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis: A case report. World J Clin Cases 2022; 10(29): 10629-10637 [PMID: 36312508 DOI: 10.12998/wjcc.v10.i29.10629]
Corresponding Author of This Article
Lu Yu, PhD, Doctor, Full Professor, Department of Hepatopanc- reatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun 130000, Jilin Province, China. yulu225@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Clin Cases. Oct 16, 2022; 10(29): 10629-10637 Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10629
Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis: A case report
Jin-Wei Zhao, Xin-Hua Cui, Wei-Yi Zhao, Lei Wang, Lin Xing, Xue-Yuan Jiang, Xue Gong, Lu Yu
Jin-Wei Zhao, Xin-Hua Cui, Wei-Yi Zhao, Lin Xing, Xue-Yuan Jiang, Lu Yu, Department of Hepatopancreatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun 130000, Jilin Province, China
Wei-Yi Zhao, Medical College of Yanbian University, Yanbian 133002, Jilin Province, China
Lei Wang, Xue Gong, Department of Imaging Surgery of Second Hospital of Jilin University, Jilin University, Changchun 130000, Jilin Province, China
Author contributions: Zhao JW, Cui XH, Yu L, and Zhao WY contributed to the manuscript design and drafting, and reviewed the literature; Wang L and Gong X contributed to analysis and interpretation of the imaging findings, and revision of the manuscript; Zhao JW, Jiang XY, and Xing L performed exploratory surgery, managed the patient, and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: The patient provided informed written consent prior to treatment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lu Yu, PhD, Doctor, Full Professor, Department of Hepatopanc- reatobiliary Surgery of Second Hospital of Jilin University, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of The Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun 130000, Jilin Province, China. yulu225@126.com
Received: April 19, 2022 Peer-review started: April 19, 2022 First decision: June 2, 2022 Revised: June 21, 2022 Accepted: September 1, 2022 Article in press: September 1, 2022 Published online: October 16, 2022 Processing time: 163 Days and 6.7 Hours
Abstract
BACKGROUND
Mesenteric ischemia represents an uncommon complication of splanchnic vein thrombosis, and it is less infrequently seen in young women using oral contraceptives. Diagnosis is often delayed in the emergency room; thus, surgical intervention may be inevitable and the absence of thrombus regression or collateral circulation may lead to further postoperative ischemia and a fatal outcome.
CASE SUMMARY
We report a 28-year-old female patient on oral contraceptives who presented with acute abdominal pain. Her physical examination findings were not consistent with her symptoms of severe pain and abdominal distention. These findings and her abnormal blood tests raised suspicion of acute mesenteric ischemia (AMI) induced by splanchnic vein thrombosis. Contrast-enhanced abdominal computed tomography revealed ischemia of the small intestine with portomesenteric and splenic vein thrombosis (PMSVT). We treated the case promptly by anticoagulation after diagnosis. We then performed delayed segmental bowel resection after thrombus regression and established collateral circulation guided by collaboration with a multidisciplinary team. The patient had an uneventful postoperative course and was discharged 14 d after surgery and took rivaroxaban orally for 6 mo. In subsequent follow-up to date, the patient has not complained of any other discomfort.
CONCLUSION
AMI induced by PMSVT should be considered in young women who are taking oral contraceptives and have acute abdominal pain. Prompt anticoagulation followed by surgery is an effective treatment strategy.
Core Tip: Mesenteric ischaemia is an uncommon complication of portomesenteric and splenic vein thrombosis (PMSVT) due to oral contraceptive. We report here a case of mesenteric ischaemia secondary to PMSVT, in which contrast-enhanced abdominal computed tomography played a key role in confirming the diagnosis. This report aims to contribute more information concerning the clinical characteristics as well as demonstrate that prompt anticoagulation followed by surgical invention is an effective strategy and importance of collaboration of multi-disciplinary teamwork for management of acute mensenteric ischemia caused by PMSVT.
