Giannos Aris, Stavrou Sofoklis, Goumalatsos Nikolaos, Fragkoulidis George, Chra Eleni, Argiropoulos Dimitrios, Loutradis Dimitrios, Drakakis Peter
1st OB/GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave, 11528, Athens, Greece.
2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Med Case Rep. 2017 Jul 7;11(1):184. doi: 10.1186/s13256-017-1320-5.
Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation.
A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks' gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day.
To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.
肠系膜囊肿是一种罕见的临床病症，在妊娠期尤为少见；因此，文献中报道的病例较少。其标准治疗方法是通过剖腹手术或腹腔镜手术进行手术切除。此外，肠系膜静脉血栓形成在妊娠期是一种罕见且危及生命的病症，由于它可导致肠道坏死性缺血，因此需要立即治疗。这是妊娠期肠系膜囊肿与肠系膜静脉血栓形成并存的首例报告。
一名27岁的希腊女性，孕2产1，妊娠10周时到我院急诊科就诊，主诉弥漫性腹痛，近3天加重，疼痛局限于右下腹，并伴有呕吐。她23岁时因卵巢囊肿接受过开腹剖腹手术及右侧输卵管卵巢切除术。除此之外，她的个人及家族病史均无异常。她从未服用过口服避孕药或接受过任何激素治疗。入院时，临床检查发现右下腹触诊有压痛，无反跳痛或肌紧张。住院10小时内，她的症状进一步恶化，检查时出现反跳痛、心动过速，血细胞比容值下降了12个单位。遂进行了急诊剖腹手术。术中发现两个肠系膜囊肿以及一段60厘米长的坏死肠段。术后，她主诉急性腹痛、心动过速及呼吸困难。计算机断层扫描成像显示肠系膜静脉血栓形成及肺血栓栓塞。她接受了低分子量肝素治疗，并于术后第11天出院。
据我们所知，这是文献中首例妊娠期同时出现肠系膜囊肿和肠系膜静脉血栓形成的报告。众所周知，妊娠是一种高凝状态，临床医生在诊断急性腹痛时应牢记这种罕见的临床病症。
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