Oral contraceptive and acute intestinal ischemia with mesenteric venous thrombosis: a case report

Mesenteric and portal vein thrombosis, a rare complication in a patient with polycystic ovary syndrome: A case report and review of literature

INTRODUCTION AND IMPORTANCE

One of the rare complications of polycystic ovarian syndrome (PCOS) treated with combination contraceptives is venous thrombosis. However, there is currently no information on intestinal necrosis and portal venous thrombosis in polycystic ovary syndrome patients, and diagnosis is frequently delayed in these situations.

CLINICAL PRESENTATION

We report a case of a 30-year old female patient who experienced a sudden onset of rectal bleeding and severe abdominal pain. Superior mesenteric vein thrombosis was detected with Doppler ultrasonography. Right portal vein thrombosis was discovered on contrast-enhanced tomography of the abdomen; it was treated with enoxaparin sodium without improvement. A colonoscopy was then conducted; it revealed a distal descending colon with proximal sigmoid colon ischemia alterations. During a laparoscopic, ischemic portion were removed. On follow-up after two weeks, the patient was still on enoxaparin sodium (80 mg twice daily) in good general condition.

CLINICAL DISCUSSION

Portal vein thrombosis (PVT) and Superior mesenteric venous thrombosis (MVT) are rare forms of venous thrombosis and unusual conditions. Superior MVT related to hormonal contraception and PCOS is uncommon. To best of our knowledge, here we report the first case of PCOS presented with acute intestinal ischemia related to MVT.

CONCLUSION

Except for the correlation between PCOS and the use of combination contraceptives, no predisposing factor for portal vein thrombosis was found. Our case report indicates the need for clinicians to consider acute intestinal ischemia in patients with polycystic ovarian disease who have acute abdominal pain and atypical site of thrombosis.

Hypercoagulable Factors Attributing to Superior Mesenteric Vein Thrombosis and Acute Mesenteric Ischemia

Acute mesenteric ischemia is rare and can be difficult to diagnose due to vague symptoms often endorsed by patients. It can be fatal if not discovered in time, as it can lead to bowel ischemia, sepsis, and ultimately death. Here, we present a case of a 23-year-old female with hepatic steatosis, obesity, and 5-year history of birth control use who developed acute mesenteric ischemia secondary to superior mesenteric venous (SMV) thrombosis, requiring small bowel resection of 238 cm out of 480 cm (49.5%) after delay in diagnosis. Hypercoagulable and genetic workup during admission later revealed heterozygous factor V Leiden (FVL) mutation. The patient was ultimately discharged to inpatient rehabilitation on anticoagulation.

Continuous Use of Combined Hormonal Contraceptive and the Effect on Blood Coagulation Factors in Female Capuchin Monkeys (Sapajus libidinosus)

This study aimed at evaluating the availability of the primate Sapajus libidinosus as an animal model for research assessing the physiological effects of the continuous use of combined hormonal contraceptives. In order to do this, six reproductively active female S. libidinosus from the Primate Research Center of the University of Brasília were selected to take part in this experiment. Every 21 days or so, each female received a single dose of combined hormonal contraceptive (algestone acetophenide and 17-enanthate estradiol) in a total of five doses throughout the experiment. The physiological parameters were accessed by means of 13 blood samples from each female, whereas three were gathered during the baseline and 10 samples were collected during the treatment phase. The results showed that the contraceptive use provoked changes in hematological coagulation factors such as an increase in the amount of platelets (p = 0.039) and a reduction in both prothrombin (p < 0.001) and thromboplastin coagulation time (p < 0.001). These results are similar to what has been observed in human patients; thus, it is concluded that S. libidinosus can be successfully used in studies about the physiological impact of hormonal contraceptives.

Small Bowel Lesions Mimicking Crohn's Disease

PURPOSE OF REVIEW

Not all injuries of the terminal ileum are Crohn's disease. It is the purpose of this review to consider the differential diagnosis of other acute and chronic ileal lesions.

RECENT FINDINGS

The recognition of a granulomatous disease of the terminal ileum, distinct from tuberculosis, dates back over 85 years and perhaps much farther, but over the past decades, many other clinical pathologic entities have been described that are neither tuberculosis nor Crohn's eponymous regional enteritis. In recent years, the catalog of lesions mimicking Crohn's disease of the small bowel and proposals for differential diagnosis and treatment have expanded to include newly reported appendiceal pathology, primary cancers and lymphomas of the intestine, unexpected metastases from distant organs, unusual infections, vasculitides and other ischemic conditions, Behçet's disease, endometriosis, and drug reactions. A diagnosis of Crohn's disease should not be a reflex action in the face of small bowel structural or inflammatory lesions without consideration of pathology in adjacent organs, primary and metastatic lesions of the small intestine, infections, vascular diseases, infiltrative diseases, drug injury, or other "idiopathic" conditions.