A Case of the Bowel Obstruction due to a Superior Mesenteric Arterial Thrombosis caused by Protein C Deficiency

Kazumi Ikenishi, Tomohide Mukogawa, Hisao Fujii, Michinori Hisanaga, Fumikazu Koyama, Hiroshi Matsumoto, Hidehiko Shimatani, Taku Takeuchi and Yoshiyuki Nakajima

Department of Surgery, Nara Medical University

We report a case of bowel obstruction due to superior mesenteric artery (SMA) thrombosis caused by Protein C deficiency. A 49-year-old man admitted to emergency room for severe abdominal pain in March 2002 after stopping warfarin treatment (8 mg/day) on his own. He had been diagnosed with Protein C deficiency in 1990 and had continued under outpatient follow-up. Computed tomography (CT) indicated possible superior mesenteric artery thrombosis. Contrast-medium bowel wall enhancement indicated no sign of bowel necrosis, so we undertook thrombolytic and anticoagulant therapy, with the thrombus disappearing, three weeks later. During the next two months, with oral ingestion, he had a fever and abdominal pain repeatedly. Colonoscopy and gastrografin contrast study through a long tube, which indicated extensive stricture from the distant ileum to the transverse colon. Diagnosing the ischemic stricture as irreversible, we conducted right hemicolectomy, partial distant ileal resection, and loop ileostomy. The postoperative course was uneventful and the man was discharged once the loop ileostomy was closed. We review three cases of SMA thrombosis coused by protein C deficiency reported in the literature, and report our case to broaden knowledge on this subject.

Key words
protein C deficiency, superior mesenteric arterial thrombosis, bowel obstruction

Reprint requests
Kazumi Ikenishi Department of Surgery, Saiseikai Gose Hospital
20 Mimuro, Gose, Nara, 639-2306 JAPAN

Accepted
December 17, 2008

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