A Cases of Mesenteric Vein Thrombosis Secondary to Protein S Deficiency

Kimimasa Ikeda, Takashi Shimano, Masashi Kitada, Yasuo Tsukahara, Takashi Shibata, Yukio Fukushima, Shinsuke Hata, Kenzou Akagi, Masaki Okuyama and Yuji Takahashi

Department of Surgery, Toyonaka Municipal Hospital

We report a case of mesenteric vein thrombosis. A 44-year-old man referred to our hospital for abdominal pain, melena, and fever after deep vein thrombosis was found to have a palpable dilated intestine with localized peritonitis. Colonospopy showed congestive necrosis of the sigmoid colon, necessitating emergency laparotomy. Operative findings showed inferior mesenteric vein thrombosis with congestion from the descending colon to rectosigmoid and congestive necrosis of the sigmoid colon. Resection from the transverse colon to rectosigmoid with colostomy was done. Although the patient was treated with heparin, superior mesenteric vein thrombosis occurred on postoperative day 46. Interventional radiology using urokinase and heparin prevented necrosis of the small intestine but the ischemic jejunal stricture had to be resected. Laboratory examination showed coagulation disorder of the lower level of protein S. This mesenteric vein thrombosis is thought to be based on protein S deficiency.

Key words
IMV thrombosis, SMV thrombosis, protein S deficiency

Reprint requests
Kimimasa Ikeda Department of Surgery, Toyonaka Municipal Hospital 4-14-1 Shibahara-cho, Toyonaka, 560-0055 JAPAN

Accepted
December 12, 2001

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