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Case Reports
. 2021 Feb 4;13(2):e13129.
doi: 10.7759/cureus.13129.

A Case of Duodenal Resection and Duodenojejunostomy for Multiple Small Bowel Infarction in Patient With Inherited Thrombophilia and Vitamin K Antagonist Induced Critical Hypocoagulation

Badri Kobalava  1   2   3 , Anzor Kvashilava  3 , Giorgi Giorgobiani  2   3 , Irina G Datikashvili-David  4 , Nana Turava  5
Affiliations
Case Reports

A Case of Duodenal Resection and Duodenojejunostomy for Multiple Small Bowel Infarction in Patient With Inherited Thrombophilia and Vitamin K Antagonist Induced Critical Hypocoagulation

Badri Kobalava et al. Cureus. .

Abstract

We present a case of the multiple venous intestinal infarction in patient with two inherited thrombophilias: Leiden factor V (LFV) and factor VIII elevation. The patient had a critical hypocoagulation caused by vitamin K antagonist (VKA) overdose. At laparotomy, several intestinal segments were necrotic and ischemic. Coagulopathy was corrected by the transfusion of the fresh frozen plasma. Because of the 4th duodenal segment infarction distal segmental duodenectomy with side-to-side duodenojejunostomy was done, which is a rarely performed procedure. On postoperative day 6 deep vein thrombosis developed, despite nadroparin profillaxes, early mobilisation and compressive stockings. Our case demonstrated that in patients with congenital thrombophilia, development of the mesenteric venous thrombosis is possible even with VKA induced severe hypocoagulation. Venous infarction of the small bowel can be associated with the hemoperitoneum and gastrointestinal bleeding. After resection of the fourth duodenal segment, side-to-side duodenojejunostomy is a feasible method of reconstruction.

Keywords: anticoagulation; apc resistance; clotting disorders; duodenal resection; duodenojejunostomy; factor v leiden; intestinal infarction; small intestine; thrombophilia; venous thrombosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT sagittal reconstruction.
The stomach (white arrow) and duodenum (green arrow) are distended. The distal duodenum, DJ junction, and initial jejunum (blue arrow) are swollen.
Figure 2
Figure 2. Laparotomy revealed hemoperitoneum.
Fourth portion of the duodenum (white arrow) and initial jejunum (blue arrow) are necrotic.
Figure 3
Figure 3. Second necrotic jejunal segment.
Figure 4
Figure 4. Ischemic segment of the ileum.
Figure 5
Figure 5. Side-to-side duodenojejunostomy (arrow).
See this image and copyright information in PMC

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