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Thromboembolism in inflammatory bowel diseases: a report from Saudi Arabia.

Issa H, Al-Momen S, Bseiso B, Al-Janobi GA, Aljama MA, Almousa FA, Al-Jarodi ME, Al-Salem AH - Clin Exp Gastroenterol (2011)

Bottom Line: In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing.Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare.This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia;

ABSTRACT
Thromboembolism (TE) is a serious but under-recognized complication of inflammatory bowel disease (IBD). This is specially so in developing countries where the incidence of IBD is low. In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing. Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare. This report describes six IBD patients with TE. This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus

CT scan of the abdomen showing inferior vena cava thrombosis (single arrow). Note also partial obstruction at the distal ileum with significant dilated proximal bowel loops and bowel thickening (double arrow).
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f1-ceg-4-001: CT scan of the abdomen showing inferior vena cava thrombosis (single arrow). Note also partial obstruction at the distal ileum with significant dilated proximal bowel loops and bowel thickening (double arrow).

Mentions: A 23-year-old, nonsmoking, Saudi male was referred to our hospital complaining of abdominal pain for 18 months. He was well until 14 months prior to presentation, when he started to complain of intermittent colicky, mostly right-sided abdominal pain, not related to meals and associated with occasional nausea, vomiting, and frequent bowel motion up to six or seven times daily but without blood or mucous. Four months after developing the pain, his appetite decreased and he lost 30 kg in weight. His family history was unremarkable except for a history of CD in third-degree relatives. On examination he was found to be thin built and not in distress, and his vital signs were normal. His abdomen was mildly tender in the right upper quadrant with no palpable masses or organomegaly. Laboratory investigations showed the following: white blood cell count (WBC) 5.34 × 109/L, hemoglobin (Hb) 7.4 g/dL, hematocrit 24.7%, platelets 701 × 109/L, erythrocyte sedimentation rate (ESR) 75 mm/h, total bilirubin 1.5 umol/L, alkaline phosphatase 100 unit/L, alanine aminotransferase 25 unit/L, aspartate aminotransferase 24 unit/L, γ-glutamyl transpeptidase 16 unit/L, total protein 56 g/L, albumin 15 g/L, phosphorus 1.29 mmol/L, calcium 1.93 mmol/L, antithrombin III 90.1 sec (normal 75–125), activated protein C resistance 88 (normal 70–140), and protein S 54.8 L (normal 50–120). Lower gastrointestinal endoscopy showed ileitis with nodular terminal ileal mucosa and aphthous ulcers with normal colon. Multiple biopsies were taken and the histopathology revealed CD. Computed tomography (CT) enterography showed segmental wall thickening of the ileal loops with creeping fat and enlarged mesenteric lymph nodes most likely representing CD as well as partial obstruction at the distal ileum with significant dilated proximal bowel loops. There was also inferior vena cava thrombosis with central intraluminal filling defect extending to the right internal iliac vein (Figures 1 and 2). Pulmonary CT revealed small subsegmental pulmonary emboli. This was treated with low-molecular-weight heparin. There was no family history of TE. He was started on Pentasa, gradually increasing the dose until it reached 1 g three times daily + Caltrate, iron, and vitamin D supplements. Azathioprine was introduced with a dose of 50 mg once daily. He quickly responded to treatment and his laboratory follow-up showed a rise in his hemoglobin level reaching 10 g/dL, normalization of his calcium level, and elevation of his albumin level reaching 28 g/L. His inflammatory markers, including ESR and CRP, gradually came down.


Thromboembolism in inflammatory bowel diseases: a report from Saudi Arabia.

Issa H, Al-Momen S, Bseiso B, Al-Janobi GA, Aljama MA, Almousa FA, Al-Jarodi ME, Al-Salem AH - Clin Exp Gastroenterol (2011)

CT scan of the abdomen showing inferior vena cava thrombosis (single arrow). Note also partial obstruction at the distal ileum with significant dilated proximal bowel loops and bowel thickening (double arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108676&req=5

f1-ceg-4-001: CT scan of the abdomen showing inferior vena cava thrombosis (single arrow). Note also partial obstruction at the distal ileum with significant dilated proximal bowel loops and bowel thickening (double arrow).
Mentions: A 23-year-old, nonsmoking, Saudi male was referred to our hospital complaining of abdominal pain for 18 months. He was well until 14 months prior to presentation, when he started to complain of intermittent colicky, mostly right-sided abdominal pain, not related to meals and associated with occasional nausea, vomiting, and frequent bowel motion up to six or seven times daily but without blood or mucous. Four months after developing the pain, his appetite decreased and he lost 30 kg in weight. His family history was unremarkable except for a history of CD in third-degree relatives. On examination he was found to be thin built and not in distress, and his vital signs were normal. His abdomen was mildly tender in the right upper quadrant with no palpable masses or organomegaly. Laboratory investigations showed the following: white blood cell count (WBC) 5.34 × 109/L, hemoglobin (Hb) 7.4 g/dL, hematocrit 24.7%, platelets 701 × 109/L, erythrocyte sedimentation rate (ESR) 75 mm/h, total bilirubin 1.5 umol/L, alkaline phosphatase 100 unit/L, alanine aminotransferase 25 unit/L, aspartate aminotransferase 24 unit/L, γ-glutamyl transpeptidase 16 unit/L, total protein 56 g/L, albumin 15 g/L, phosphorus 1.29 mmol/L, calcium 1.93 mmol/L, antithrombin III 90.1 sec (normal 75–125), activated protein C resistance 88 (normal 70–140), and protein S 54.8 L (normal 50–120). Lower gastrointestinal endoscopy showed ileitis with nodular terminal ileal mucosa and aphthous ulcers with normal colon. Multiple biopsies were taken and the histopathology revealed CD. Computed tomography (CT) enterography showed segmental wall thickening of the ileal loops with creeping fat and enlarged mesenteric lymph nodes most likely representing CD as well as partial obstruction at the distal ileum with significant dilated proximal bowel loops. There was also inferior vena cava thrombosis with central intraluminal filling defect extending to the right internal iliac vein (Figures 1 and 2). Pulmonary CT revealed small subsegmental pulmonary emboli. This was treated with low-molecular-weight heparin. There was no family history of TE. He was started on Pentasa, gradually increasing the dose until it reached 1 g three times daily + Caltrate, iron, and vitamin D supplements. Azathioprine was introduced with a dose of 50 mg once daily. He quickly responded to treatment and his laboratory follow-up showed a rise in his hemoglobin level reaching 10 g/dL, normalization of his calcium level, and elevation of his albumin level reaching 28 g/L. His inflammatory markers, including ESR and CRP, gradually came down.

Bottom Line: In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing.Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare.This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia;

ABSTRACT
Thromboembolism (TE) is a serious but under-recognized complication of inflammatory bowel disease (IBD). This is specially so in developing countries where the incidence of IBD is low. In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing. Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare. This report describes six IBD patients with TE. This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus