A Case of Superior Mesenteric Vein Thrombosis Caused by Protein C Deficiency

Toshiki Yamakawa, Yuji Onoda, Ryuichirou Ohashi, Sadanobu Izumi, Ichio Suzuka and Kunihiko Shiota

Department of Surgery, Kagawa Prefectural Central Hospital

We report a case of superior mesenteric vein thrombosis (SMVT) caused by protein C deficiency. A 63-year-old man with nausea and epigastralgia treated for acute enteritis had had a quite normal stomach appearance in his gastrointestinal endoscopy examination, but his symptoms did not improve so he went to the hospital again. During this visit, doctors decided via computed tomography and multiplanar reformation that he may have SMVT. We conducted emergency laparotomy, finding hemorrhagic ascites and congestive necrosis of the small intestine. We removed the thrombus in the superior mesenteric vein, resected the necrotic segment of the small intestine (90 cm, including a seemingly normal section), and conducted end-to-end anastmosis. We observed patency of the superior mesenteric artery and occlusion of the superior mesenteric vein with the thrombus. A preoperative coagulation study showed low levels of and as lowered activity of the protein C antigen. We have reviewed the two cases reported in the Japanese literature of SMVT caused by a protein C deficiency, and we make this report to broaden knowledge available on this topic.

Key words
superior mesenteric vein thrombosis, protein C deficiency

Reprint requests
Toshiki Yamakawa Department of Surgery, Kagawa Prefectural Central Hospital
5-4-16 Ban-cho, Takamatsu, 760-8557 JAPAN

Accepted
July 26, 2006

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