Dahshan Ahmed, Donovan Kevin
Division of Pediatric GI and Nutrition, College of Medicine, Oklahoma University Health Science Center-Tulsa, 2815 South Sheridan, Tulsa, OK 74129, U.S.A.
J Clin Gastroenterol. 2002 May-Jun;34(5):554-6. doi: 10.1097/00004836-200205000-00015.
A 4-year-old boy was evaluated for recurrent abdominal pain and failure to thrive over a 1-year period in a pediatric subspecialty clinic. Results of the extensive workup mostly were unremarkable. Eventually, imaging studies of the abdominal aorta revealed an isolated thrombosis of the superior mesenteric artery trunk and compensatory hypertrophy of the inferior mesenteric artery. He had been having abdominal angina symptoms and fear of eating. A detailed family history suggested a possible hypercoagulable state. However, an extensive hematologic evaluation did not reveal a recognizable defect that could produce thrombotic events. He was treated by arterial graft bypass surgery and started on conventional anticoagulants. Several months later, he developed repeat, near-total thrombosis of the graft with recurrence of his symptoms. After balloon dilation of the graft and starting him on appropriate anticoagulant maintenance regimen, he had good symptom relief, and the graft remained patent. This presentation was unusually prolonged for the type of vascular problem identified. The possibility of vascular problems in children, therefore, should be considered. Unidentified cause of hereditary clotting tendency is another challenging aspect of this case.
一名4岁男孩因反复腹痛和在1年时间里生长发育迟缓，在一家儿科专科诊所接受评估。全面检查的结果大多无异常。最终，腹主动脉的影像学检查显示肠系膜上动脉主干孤立性血栓形成以及肠系膜下动脉代偿性肥大。他一直有腹部绞痛症状且害怕进食。详细的家族史提示可能存在高凝状态。然而，全面的血液学评估未发现可导致血栓形成事件的可识别缺陷。他接受了动脉移植搭桥手术，并开始使用传统抗凝剂治疗。几个月后，移植血管再次出现几乎完全血栓形成，症状复发。在对移植血管进行球囊扩张并开始给他使用适当的抗凝维持治疗方案后，他的症状得到了很好的缓解，移植血管保持通畅。对于所确定的血管问题类型，这种临床表现异常迁延。因此，应考虑儿童血管问题的可能性。遗传性凝血倾向的不明原因是该病例的另一个具有挑战性的方面。
