Clinical communication: Adults| Volume 39, ISSUE 5, P579-582, November 2010

Mesenteric Ischemia and Protein S Deficiency: A Rare Case Report


      We present an unusual case of a 31-year-old nulliparous woman who was in her normal state of health until 3 weeks before her Emergency Department visit, when she began to have generalized abdominal pain that got acutely worse over a few days. She had a soft abdomen, but complained of excruciating pain. Her computed tomography (CT) scan revealed thrombosis in the superior mesenteric, splenic, and portal veins. Her hematological work-up detected a protein S deficiency, which is associated with recurrent venous thrombosis. The finding of mesenteric venous thrombosis associated with protein S deficiency is rare. The most important factor in survival is early diagnosis and prompt treatment with anticoagulants. Properly treated, patients with mesenteric venous thrombosis should have a good long-term prognosis. Past medical or family history of thrombosis in combination with abdominal symptoms should increase the suspicion for the disease.


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        • Aneja R.
        • Heard C.
        • Petruzze M.
        • Waz W.
        • Martin D.
        Protein S deficiency manifesting as spontaneous aortic thrombosis in a neonate.
        Pediatr Crit Care Med. 2002; 3: 81-83
        • Broekmans A.W.
        • Van Rooyen W.
        • Westerveld B.D.
        • et al.
        Mesenteric vein thrombosis as presenting manifestation of hereditary protein S deficiency.
        Gastroenterology. 1987; 92: 240-242
        • Engesser L.
        • Broekmans A.
        • Briet E.
        • et al.
        Hereditary protein S deficiency: clinical manifestations.
        Ann Intern Med. 1987; 106: 677-682
        • Hoffman R.
        • Benz E.
        • Shattil S.
        Hypercoagulable states.
        in: Hematology: basic principles and practice. 2nd edn. Churchill Livingstone, New York1995: 465-468
        • Inagaki H.
        • Sakakibara A.
        • Miyaike H.
        • et al.
        Mesenteric venous thrombosis in familial free protein S deficiency.
        Am J Gastroenterol. 1993; 88: 134-138
        • Kitchens C.
        Evolution of our understanding of pathophysiology of primary mesenteric venous thrombosis.
        Am J Surg. 1992; 163: 346-348
        • Koenen R.R.
        • Christella M.
        • Thomassen L.G.
        • Tans G.
        • Rosing J.
        • Hackeng T.M.
        Effect of oral contraceptives on the anticoagulant activity of protein S in plasma.
        Thromb Haemost. 2005; 93: 853-859
        • Morasch M.
        • Ebaugh J.
        • Chiou A.
        • et al.
        Mesenteric venous thrombosis: a changing clinical entity.
        J Vasc Surg. 2001; 34: 690-694
        • Onwuanyi A.
        • Sachdeva R.
        • Hamirani K.
        • et al.
        Multiple aortic thrombi associated with protein C and S deficiency.
        Mayo Clin Proc. 2001; 76: 319-322
        • Simioni P.
        • Zanardi S.
        • Saracino A.
        • Girolami A.
        Occurrence of arterial thrombosis in a cohort of patients with hereditary deficiency of clotting inhibitors.
        J Med. 1992; 23: 61-74
        • Zigrossi P.
        • Campanini M.
        • Bordin G.
        • et al.
        Portal and mesenteric thrombosis in protein S deficiency.
        Am J Gastroenterol. 1996; 91: 164-165
        • Grisham A.
        • Lohr J.
        • Guenther J.M.
        • Engel A.M.
        Deciphering mesenteric venous thrombosis: imaging and treatment.
        Vasc Endovascular Surg. 2005; 39: 473-479
        • Kaplan J.L.
        • Weintraub S.L.
        • Hunt J.P.
        • Gonzalez A.
        • Lopera J.
        • Brazzini A.
        Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric catheter.
        Am Surg. 2004; 70: 600-604