Increased activity of Factor VIII causing acute intestinal ischemic disorder with recurrent and multiple arterial thromboses

Acute intestinal ischemic disorders are potentially life threatening, making early diagnosis and emergency surgery crucial. Although hypercoagulability may induce mesenteric venous thrombosis, its association with mesenteric arterial thromboembolism remains controversial. We present the case of a 52-year-old man with hypercoagulability-induced acute arterial occlusive mesenteric ischemia. The patient suffered from arterial occlusive mesenteric ischemia, recent ischemic stroke, and previous renal infarction. He had no history of atrial fibrillation, atherosclerosis, vascular diseases, autoimmune diseases, malignancy, liver diseases, copper deficiency, or other risk factors for arterial thromboembolism. Segmental resection of the gangrenous bowel with primary end-to-end anastomosis was performed. A pathological examination revealed multiple thrombi within the mesenteric arteries of the infarcted bowel without apparent atherosclerosis of the vessels. The plasma level of factor VIII was high even 64 months postoperatively, which may have contributed to the recurrent and multiple arterial thromboses. A lifelong oral anticoagulation therapy was suggested. From our experience, we recommend that thrombophilia screening be performed in patients with acute intestinal ischemic disorders, particularly in those with a history of recurrent or multiple thromboembolism. Anticoagulant therapy should be prescribed for those with hypercoagulability