Thrombophilia in a patient with short bowel syndrome

Abstract

This article presents a clinical case of thrombophilia in a patient with short bowel syndrome. Thrombophilia is characterized by a disorder of the blood clotting system, in which the risk of thrombosis increases. Thrombophilia, local vascular insufficiency, intestinal obstruction with fistula formation requiring intestinal resection play a significant role in the pathogenesis of short bowel syndrome. The patient was admitted with the diagnosis “thrombophilia, resection of the small intestine (residual small intestine 17 cm), ileostoma”. Condition after multiple surgical interventions on the abdominal cavity. Surgeries performed: atypical gastric resection, resection of the greater omentum, jejunostomy, resection of the cardial and antral parts of the stomach, derivation of duodenostomy, esophagostomy, derivation of loop jejunostomy, Braun enteroanastomosis, perforation of the colon, suturing, derivation of colostomy, cholecystectomy, GI reconstruction, Roux esophagoenteroanastomosis, resection of the sigmoid colon, small intestine, bearing intestinal fistulas, removal of double-barrel ileostomy, abdominal cavity drainage, relaparotomy, closure of ileal perforation, retrograde intubation of the small intestine, determination of indications for intestinal transplantation. The following tests were performed: CT-enterography, colonoscopy with subsequent morphological examination, abdominal ultrasound, enterogastroscopy, clinical and biochemical blood tests, PCR, coagulogram, urinalysis, percussion and auscultation of the chest. Morphological examination showed fragments of the wall of the colon – with erosion, fragments of fatty tissue – with immature granulation tissue, fragment of stroma covered with multilayer flat keratinized epithelium with the focus of epithelized slit-like ulcer. Clexane was administered as part of the treatment complex, nutritional support additionally included Micrazyme capsules 25000 units, teduglutide, remabipid. Rebamipid and Teduglutide allowed to stabilize the patient's condition and improve the condition of the perioperative area tissues. In case of ineffectiveness of the therapy used the indications for liver transplantation are determined.