Mesenteric venous thrombosis associated with oral contraceptives: a case report

Abstract

Small-bowel infarction resulting from mesenteric venous thrombosis is a rare but life-threatening complication to which young women taking oral contraceptives are liable. The patient characteristically presents with an "acute abdomen" after a variable prodromal period of vague abdominal pain. The correct diagnosis can be made from the macroscopic appearance at laparotomy, provided the surgeon is alert to the condition. An accurate diagnosis is important, as anticoagulation measures must be instituted early to counter the commonly associated thromboembolic phenomena.

PIP: A case report of mesenteric venous thrombosis with small bowel infarction in a 38-year-old woman who had been taking oral contraceptives is reported. The patient was admitted complaining of severe abdominal pain and vomiting for 36 hours. On admission, temperature was 37.5 degrees C and pulse 120/minute. Abdominal rigidity and left-sided abdominal tenderness were present. X-ray of the abdomen showed 2 distended loops of small bowel and 3 fluid levels. Serum amylase was normal. White cell count was 10,000/cu mm. There was a history of abdominal pain and diarrhea over a period of several years. For 6 months she had been taking Ovulen (mestranol .1 mg and ethynodiol diacetate .5 mg) for menstrual irregularity. 2 weeks earlier she had suffered an influenzalike illness with pleuristic chest pain, loin pain, urinary frequency, and dysuria. Chest X-ray and intravenous pylography were then reported as normal. At immediate operation, a 15 cm segment of ileum was found to be infarcted. Semipurulent fluid was present in the abdomen and areas of fibrinous peritonitis were observed. The involved segment of ileum was resected. A small thrombus was extracted from a mesenteric vein. Initial postoperative course was good but 3 days after operation chest pain, dyspnea, and giddiness developed and cardiac arrest followed. Resuscitation was successful. Pulmonary angiography then showed thrombi in all branches of the pulmonary artery. After heparin therapy symptoms improved and the patient left the hospital in 2 weeks, her condition being stabilized with warfarin and dipyridamole (Persantin). The diagnosis was confirmed by histological examination. Early recanalization of a mesenteric vein was noted. Other reported cases have shown an average prodromal phase of 4 or 5 days. The long-term diarrhea was considered as not connected with the present illness but the presumed influenza illness 2 weeks earlier may have been due to a pulmonary embolism. Of reported cases, 5 of 13 have died. Early diagnosis, prompt surgery, and heparin therpay are considered important.