A Case of Primary Mesenteric Venous Thrombosis in Puerperal Patient with Nephrotic Syndrome

Shin-ichi Nishiyama, Masatomo Ootsuka, Nobuki Matsunami, Terutoshi Nakao, Migaku Matsuoka*

Department of Surgery and Pathology*, PL General Hospital

We reported a case of nephrotic syndrome in which there was a primary mesenteric venous thrombosis at puerperium. A 24-year-old woman treated for nephrotic syndrome for the previous seven months was admitted to PL General Hospital for delivery. On the 18th day after the delivery she experienced a sudden onset of upper abdominal pain, and signs of peritoneal irritation gradually appeared. Peritoneal puncture revealed bloody ascitic fluld. Exploratory laparotomy was carried out on the 6th day after the initial symptoms, with the diagnosis of acute peritonitis. A dark necrotic section of the small bowel extending from about 1 m distal to the ligament of Treitz to about 80 cm proximal to the ileocecal valve was found. Multiple mesenteric veins of the necrotic segment were thrombosed and the venous blood flow was found to be interruped. An approximately 3 m segment of the small bowel was resected, and side-to-side anastomosis was carried out between the healthy bowel segments. The finding of thick-walled bowel loops on a pre-operative abdominal CT scan was helpful in the diagnosis. Although a thrombostatic defect could not be detected pre- or postoperatively, we suggest that the pathogenesis may have been related to the hypercoagulable status in the puerperal state and to the nephrotic syndrome. We believe that postoperative anticoagulant therapy and careful long-term observation should be required for these patients because of the high incidence of reinfarction.

Key words
primary mesenteric venous thrombosis, nephrotic syndrome, puerpeium

Reprint requests
Shin-ichi Nishiyama Department of Surgery, PL General Hospital
2182 Shindou, Tondabayashi, 584 JAPAN

Accepted
May 9, 1990

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