Primary Mesenteric Venous Thrombosis in a 28-Week Pregnant Woman

Objectives and Importance: Mesenteric venous throm- bosis is a very rare disorder during pregnancy. We report a 28-week pregnant woman who presented with acute abdominal pain that was proved to be due to mesenteric venous thrombosis. Clinical Presentation: A healthy, pregnant woman presented to surgical casualty with an 8-hour complaint of severe generalized abdominal pain. Clinical examination revealed a 28-week gravid uterus and a mildly distended and soft abdomen with absent bowel sounds. Sonographic findings were unremark- able. Intervention: Exploratory laparotomy revealed a gangrenous loop of the sigmoid colon, which was re- sected, and Hartmann's procedure was performed. His- topathological examination of the resected bowel tissue confirmed the diagnosis of mesenteric venous thrombo- sis. The patient was thoroughly screened for the pres- ence of an underlying hypercoagulable state such as a deficiency of protein C, protein S, antithrombin III, acti- vated protein C resistance, lupus anticoagulant, factor V Leiden, and prothrombin gene mutation. No abnormali- ties were found. Conclusion: Exploratory laparotomy and histological examination of excised bowel tissue were used to confirm a diagnosis of mesenteric venous thrombosis in a 28-week pregnant woman. The clinicians and surgeons should be alerted to such a disease espe- cially in the absence of a pre-existing hypercoagulable state. Exploratory laparotomy, which was diagnostic in this case, should not be delayed. Copyright © 2001 S. Karger AG, Basel