Portal trunk occlusion leading to small bowel resection in a context of pylephlebitis complicated by heparin-induced thrombocytopenia
(2017) Louvain médical — Vol. 136, n° 7, p. 440-449 (2017)
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- Abstract
- We here present a case of diverticulitis complicated by a pylephlebitis of the portal and superior mesenteric vein, requiring treatment with heparin and antibiotics. The patient subsequently developed a splenic vein thrombosis and suffering bowels. A large resection of the small bowel was performed, with subsequent ileostomy and parenteral nutrition. Following anticoagulation therapy initiation, a thrombocytopenia was observed, and the patient was found to have developed heparin-induced thrombocytopenia (HIT), as evidenced by high levels of anti-heparin/PF4 antibodies. Furthermore, he had a contributory family history of thrombophilia, and molecular tests confirmed that he was carrying a thrombophilic G20210A factor II mutation. To our knowledge, this is the first case report of a bowel ischemia in a context of pylephlebitis treated with heparin, leading to another rare thrombophilic syndrome: heparin-induced thrombocytopenia and thrombophilia (HITT). This article illustrates how a rare complication of a common disease and its treatment can aggravate the primary condition. We discussed the pylephlebitis and the HITT as the explanation for such a rare consequence on the bowel in the context of inherited thrombophilia.
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Bsilat, M., Léonard, D., Van Nieuwenhove, S., & Lambert, C. (2017). Portal trunk occlusion leading to small bowel resection in a context of pylephlebitis complicated by heparin-induced thrombocytopenia. Louvain médical, 136(7), 440-449. https://hdl.handle.net/2078.5/105432 (Original work published 2017)