A Case of Inferior Mesenteric Vein Thrombosis Secondary to Protein C Deficiency

Akira Toyoshima, Takeshi Endo, Sakae Nagaoka, Yoshikazu Maruyama, Keisuke Sakai, Tooru Isoyama and Tamiko Takemura*

Department of Surgery and Department of Pathology*, Japanese Red Cross Medical Center

A 22-year-old man admitted for difficulty in defecating, bloody stool, and diarrhea and diagnosed with mechanical ileus due to circulatory disorder underwent surgery 5 days later due to left abdominal pain and a hard abdomen. Operative findings showed inferior mesenteric vein thrombosis with congestion, edema, and degenerative sclerosis from the descending colon to the rectosigmoid colon. Because the colon was not necrotic, we conducted only transverse colostomy, relieving the man's symptoms. Postoperative laboratory examination showed a coagulation disorder due to protein C deficiency. IMA arteriography showed a defect in the IMV and collateral vein. Mesenteric vein thrombosis was attributed to protein C deficiency. We conducted resection from the transverse colon to the rectosigmoid with end-to-end anastomosis 2 years later, due to the lack of improvement in colon stenosis. The stenoeic region of the resected colon showed a defect of the mucosa and muscularis mucosae and marked luminal obliteration of subserosal veins. Anticoagulation therapy administered after the procedure, enabled the man to progress well, and no signs of recurrence have been seen since surgery. To our knowledge, only 2 cases, including ours, have been reported in the Japanese literature.

Key words
mesenteric vein thrombosis, inferior mesenteric vein thrombosis, protein C deficiency

Reprint requests
Akira Toyoshima Department of Surgery, Japanese Red Cross Medical Center
4-1-22 Hiroo, Shibuya-ku, 150-8935 JAPAN

Accepted
December 19, 2007

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