Abstract
We present a case of the multiple venous intestinal infarction in patient with two inherited thrombophilias: Leiden factor V (LFV) and factor VIII elevation. The patient had a critical hypocoagulation caused by vitamin K antagonist (VKA) overdose. At laparotomy, several intestinal segments were necrotic and ischemic. Coagulopathy was corrected by the transfusion of the fresh frozen plasma. Because of the 4th duodenal segment infarction distal segmental duodenectomy with side-to-side duodenojejunostomy was done, which is a rarely performed procedure. On postoperative day 6 deep vein thrombosis developed, despite nadroparin profillaxes, early mobilisation and compressive stockings.Our case demonstrated that in patients with congenital thrombophilia, development of the mesenteric venous thrombosis is possible even with VKA induced severe hypocoagulation. Venous infarction of the small bowel can be associated with the hemoperitoneum and gastrointestinal bleeding. After resection of the fourth duodenal segment, side-to-side duodenojejunostomy is a feasible method of reconstruction.
Highlights
The overall incidence of venous thrombosis is about 1.43 per 1,000 person a year [1]
We present a case of the multiple venous intestinal infarction in patient with two inherited thrombophilias: Leiden factor V (LFV) and factor VIII elevation
After resection of the fourth duodenal segment, side-to-side duodenojejunostomy is a feasible method of reconstruction
Summary
The overall incidence of venous thrombosis is about 1.43 per 1,000 person a year [1]. The 73-year-old man, white, of European descent, was hospitalized for acute recurrent abdominal pain, nausea, multiple vomiting with a large amount of coffee-ground masses, inability to pass flatus and feces, and fatigue. It was a fifth day from the onset of symptoms. LFV (G1691A heterozygous mutation) and factor VIII elevation (225%) was diagnosed and warfarin was prescribed to keep INR between 2 and 3. He used to check the coagulation state regularly once a month. After one and three months from surgery, the patient was uneventful
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