Protein C deficiency as a cause of simultaneous acute thrombosis of the superior mesenteric vein and inferior vena cava with jejunal infarction

Abstract

A 33-year-old man was admitted to hospital with a history of acute abdominal pain. On physical examination, he showed mild abdominal distention with diffuse tenderness, but no rigidity. Computed tomography scan revealed thrombi in the superior mesenteric venous thrombosis and inferior vena cava (Fig, A). Angiography showed that the portal blood supply to the liver was sufficient through the splenic vein, despite the total cessation of superior mesenteric venous flow in the portal phase. A filter was placed into the vena cava to prevent pulmonary embolism. Because signs of peritonitis continued on physical examination even after the initiation of anticoagulation therapy with tissue plasminogen activator, an emergency laparotomy was performed. A 20-cm segment of ischemic and necrotic jejunum was resected (Fig, B). The wall of the small intestine near this infarcted jejunum and the mesojejunum was edematous but not infarcted; primary anastomosis was performed. The postoperative course was uneventful.