Limits...
Clinical Outcome of a Portosplenomesenteric Venous Thrombosis in Necrotizing Acute Pancreatitis with Protein C and S Deficiency Treated by Anticoagulation Therapy Alone.

Ankouane F, Kowo M, Ngo Nonga B, Magny E, Hell Medjo E, Ndjitoyap Ndam EC - Case Rep Gastrointest Med (2015)

Bottom Line: We have maintained oral anticoagulation therapy.This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT.It is certain that the sooner the treatment is given, the better outcome will be.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde University Teaching Hospital, Yaoundé, Cameroon.

ABSTRACT
Cases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

No MeSH data available.


Related in: MedlinePlus

Upper gastrointestinal endoscopy performed after three months on oral anticoagulation. Arrows show medium varices occupying the circumference of the esophageal lumen. Fujinon EG250PE5, Japan. With the permission of the Cathedral Medical Center (CMC) in Yaoundé.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4581499&req=5

fig4: Upper gastrointestinal endoscopy performed after three months on oral anticoagulation. Arrows show medium varices occupying the circumference of the esophageal lumen. Fujinon EG250PE5, Japan. With the permission of the Cathedral Medical Center (CMC) in Yaoundé.

Mentions: The diagnosis of necrotizing AP complicated by PSMVT was done. In the absence of significant contraindications factor, the patient received low molecular weight heparin (enoxaparin 1 mg/kg subcutaneously twice daily), followed by oral warfarin on the 10th day, dose adjusted according to the International Normalized Ratio (INR). The repeated abdominal Doppler ultrasound on the 12th day from admission showed a partial recanalization of the extensive venous thrombosis, confirmed by the abdominal contrast-enhanced CT scanner on 30th day which showed collateral vessels and small bowel edema (Figure 3). For accurate diagnosis, specific tests have shown normal serum lipids, and the tests for anti-nuclear antibodies, anti-native DNA antibodies, and antiphospholipids were negative; the hemoglobin electrophoresis was AA type. On the contrary, the functional test of protein C (STA Stachrom) showed a serum rate of 25% (normal range: 80–130%, Cerba Laboratories, France) and that of the protein S (STA Staclot) was 50% (normal range: 70–130%, Cerba Laboratories, France). Upper gastrointestinal endoscopy performed three months after follow-up showed grade II esophageal varices (Figure 4). There were no adverse effects on anticoagulation after three months of follow-up.


Clinical Outcome of a Portosplenomesenteric Venous Thrombosis in Necrotizing Acute Pancreatitis with Protein C and S Deficiency Treated by Anticoagulation Therapy Alone.

Ankouane F, Kowo M, Ngo Nonga B, Magny E, Hell Medjo E, Ndjitoyap Ndam EC - Case Rep Gastrointest Med (2015)

Upper gastrointestinal endoscopy performed after three months on oral anticoagulation. Arrows show medium varices occupying the circumference of the esophageal lumen. Fujinon EG250PE5, Japan. With the permission of the Cathedral Medical Center (CMC) in Yaoundé.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581499&req=5

fig4: Upper gastrointestinal endoscopy performed after three months on oral anticoagulation. Arrows show medium varices occupying the circumference of the esophageal lumen. Fujinon EG250PE5, Japan. With the permission of the Cathedral Medical Center (CMC) in Yaoundé.
Mentions: The diagnosis of necrotizing AP complicated by PSMVT was done. In the absence of significant contraindications factor, the patient received low molecular weight heparin (enoxaparin 1 mg/kg subcutaneously twice daily), followed by oral warfarin on the 10th day, dose adjusted according to the International Normalized Ratio (INR). The repeated abdominal Doppler ultrasound on the 12th day from admission showed a partial recanalization of the extensive venous thrombosis, confirmed by the abdominal contrast-enhanced CT scanner on 30th day which showed collateral vessels and small bowel edema (Figure 3). For accurate diagnosis, specific tests have shown normal serum lipids, and the tests for anti-nuclear antibodies, anti-native DNA antibodies, and antiphospholipids were negative; the hemoglobin electrophoresis was AA type. On the contrary, the functional test of protein C (STA Stachrom) showed a serum rate of 25% (normal range: 80–130%, Cerba Laboratories, France) and that of the protein S (STA Staclot) was 50% (normal range: 70–130%, Cerba Laboratories, France). Upper gastrointestinal endoscopy performed three months after follow-up showed grade II esophageal varices (Figure 4). There were no adverse effects on anticoagulation after three months of follow-up.

Bottom Line: We have maintained oral anticoagulation therapy.This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT.It is certain that the sooner the treatment is given, the better outcome will be.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde University Teaching Hospital, Yaoundé, Cameroon.

ABSTRACT
Cases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

No MeSH data available.


Related in: MedlinePlus