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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 thrombosis in the superior mesenteric vein (arrow). Also note the ascites.
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f3-ceg-4-001: CT scan of the abdomen showing thrombosis in the superior mesenteric vein (arrow). Also note the ascites.

Mentions: A 39-year-old, nonsmoking, Saudi male with a known case of CD was diagnosed 5 years previously in a local hospital. He was started on azathioprine, prednisolone, and mesalazine, but he was not compliant to treatment. Two years later, he developed enterovesical fistula and was started on antitumor necrosis factor (TNF) (infliximab). He received four cycles with partial improvement and then was lost for follow-up. He presented to our hospital with a 20-day history of abdominal pain, distention, and fever with chills. He presented a history of intermittent fecaluria and pneumaturia for the last few months with a history of decreased appetite and weight loss of about 10 kg. During examination, his abdomen was distended with ascites and decreased bowel sounds. He underwent a CT scan, which revealed an enterocolic fistula, superior mesenteric vein thrombosis, and a few enlarged retroperitoneal and mesenteric lymph nodes (Figure 3). He was scheduled for surgery and underwent ileocecal resection, sigmoid colectomy, terminal ileostomy, and colostomy. Pathology of the resected intestines showed changes consistent with CD with ulcerations, fissuring, and fistula formation. He did not receive thromboprophylaxis postsurgery. He was stable until the 12th postoperative day when he suddenly developed shortness of breath and was found to be tachypneic, tachycardic, and hypotensive. Spiral CT of the chest showed evidence of a small left upper lobe subsegmental pulmonary embolism (Figure 4). There was no family history of TE. He was started on low-molecular-weight heparin, and his workup showed a low level of antithrombin III and factor V Leiden, suggestive of underlying thrombophilia, so he was started on warfarin with a stable hospital course and restarted on anti-TNF (infliximab). Currently, he is being followed up in the clinic, is doing well, and is waiting for closure of his stomas.


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 thrombosis in the superior mesenteric vein (arrow). Also note the ascites.
© Copyright Policy
Related In: Results  -  Collection

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

f3-ceg-4-001: CT scan of the abdomen showing thrombosis in the superior mesenteric vein (arrow). Also note the ascites.
Mentions: A 39-year-old, nonsmoking, Saudi male with a known case of CD was diagnosed 5 years previously in a local hospital. He was started on azathioprine, prednisolone, and mesalazine, but he was not compliant to treatment. Two years later, he developed enterovesical fistula and was started on antitumor necrosis factor (TNF) (infliximab). He received four cycles with partial improvement and then was lost for follow-up. He presented to our hospital with a 20-day history of abdominal pain, distention, and fever with chills. He presented a history of intermittent fecaluria and pneumaturia for the last few months with a history of decreased appetite and weight loss of about 10 kg. During examination, his abdomen was distended with ascites and decreased bowel sounds. He underwent a CT scan, which revealed an enterocolic fistula, superior mesenteric vein thrombosis, and a few enlarged retroperitoneal and mesenteric lymph nodes (Figure 3). He was scheduled for surgery and underwent ileocecal resection, sigmoid colectomy, terminal ileostomy, and colostomy. Pathology of the resected intestines showed changes consistent with CD with ulcerations, fissuring, and fistula formation. He did not receive thromboprophylaxis postsurgery. He was stable until the 12th postoperative day when he suddenly developed shortness of breath and was found to be tachypneic, tachycardic, and hypotensive. Spiral CT of the chest showed evidence of a small left upper lobe subsegmental pulmonary embolism (Figure 4). There was no family history of TE. He was started on low-molecular-weight heparin, and his workup showed a low level of antithrombin III and factor V Leiden, suggestive of underlying thrombophilia, so he was started on warfarin with a stable hospital course and restarted on anti-TNF (infliximab). Currently, he is being followed up in the clinic, is doing well, and is waiting for closure of his stomas.

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