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. 2024 Jun 28;17(1):79.
doi: 10.1186/s12245-024-00661-x.

A rare cause of abdominal pain in pregnancy - mesenteric artery thrombosis and miscarriage in a 34-year-old patient

Dóra Melicher  1 , Szabolcs Gaál  2 , Tamás Berényi  2 , Bánk Gábor Fenyves  2   3 , Norbert Nagy  4 , Péter Hegedűs  4 , András Fülöp  5 , Attila Szijártó  5 , Csaba Varga  2
Affiliations

A rare cause of abdominal pain in pregnancy - mesenteric artery thrombosis and miscarriage in a 34-year-old patient

Dóra Melicher et al. Int J Emerg Med. .

Abstract

Background: Mesenteric arterial thrombosis is an extremely rare thrombotic event, especially during pregnancy, that can cause rapid fatal consequences unless the patient receives early definitive treatment.

Case presentation: We report the case of a 34-year-old female presenting in her seventh week of gestation with severe abdominal pain who was promptly diagnosed with mesenteric artery occlusion amidst incipient miscarriage. The patient underwent a successful mesentery artery embolectomy, recovered and was later diagnosed with elevated factor VIII activity.

Conclusion: The diagnosis of mesenteric ischemia should be considered in pregnant women presenting with severe abdominal pain and any prior predisposing factors. Our case highlights the pivotal role of the emergency physician in maintaining a high index of suspicion coupled with timely and determined action. The prognosis of this high mortality condition depends on prompt diagnosis, early definite management and successful multidisciplinary cooperation.

Keywords: Early diagnosis; Emergency care; Factor VIII; Mesenteric ischemia; Pregnancy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) Filling defect within the superior mesenteric artery approximately 4 cm distal to its origin consistent with occlusion (red arrow) on the sagittal maximum intensity projection (MIP) reconstruction CTA images. (B) The occlusion resulted in (B) perfusion changes: lack of enhancement and mild dilatation of the jejunum (yellow arrows) on the portal venous phase (Reference: Semmelweis University – Medical Imaging Centre)
Fig. 2
Fig. 2
3D reconstruction of the CTA showing SMA occlusion (Reference: Semmelweis University – Medical Imaging Centre
Fig. 3
Fig. 3
A faint hypodense filling defect is seen in the S.III. segmental portal venous branch in keeping with segmental portal vein thrombosis (Reference: Semmelweis University – Medical Imaging Centre
Fig. 4
Fig. 4
At 6-month follow-up examination on portal venous phase, hyperenhancing small bowel loops with thickened bowel wall (yellow arrow) are evident at the location of prior ischemic changes. Additionally, mild surrounding fat stranding and discernible lymphadenopathy (red arrow) are noted (Reference: Semmelweis University – Medical Imaging Centre)
See this image and copyright information in PMC

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