Abuhammad Aseel, Dukmak Osama, Emar Mohammad, Sayes Saif, Jubran Fahmi, Maraka Mohammad
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Department of Surgery, al Ahli Hospital, Hebron, Palestine.
Int J Surg Case Rep. 2023 Aug;109:108606. doi: 10.1016/j.ijscr.2023.108606. Epub 2023 Aug 2.
One of the rare complications of polycystic ovarian syndrome (PCOS) treated with combination contraceptives is venous thrombosis. However, there is currently no information on intestinal necrosis and portal venous thrombosis in polycystic ovary syndrome patients, and diagnosis is frequently delayed in these situations.
We report a case of a 30-year old female patient who experienced a sudden onset of rectal bleeding and severe abdominal pain. Superior mesenteric vein thrombosis was detected with Doppler ultrasonography. Right portal vein thrombosis was discovered on contrast-enhanced tomography of the abdomen; it was treated with enoxaparin sodium without improvement. A colonoscopy was then conducted; it revealed a distal descending colon with proximal sigmoid colon ischemia alterations. During a laparoscopic, ischemic portion were removed. On follow-up after two weeks, the patient was still on enoxaparin sodium (80 mg twice daily) in good general condition.
Portal vein thrombosis (PVT) and Superior mesenteric venous thrombosis (MVT) are rare forms of venous thrombosis and unusual conditions. Superior MVT related to hormonal contraception and PCOS is uncommon. To best of our knowledge, here we report the first case of PCOS presented with acute intestinal ischemia related to MVT.
Except for the correlation between PCOS and the use of combination contraceptives, no predisposing factor for portal vein thrombosis was found. Our case report indicates the need for clinicians to consider acute intestinal ischemia in patients with polycystic ovarian disease who have acute abdominal pain and atypical site of thrombosis.
联合使用避孕药治疗多囊卵巢综合征（PCOS）的罕见并发症之一是静脉血栓形成。然而，目前尚无关于多囊卵巢综合征患者肠道坏死和门静脉血栓形成的信息，且在这些情况下诊断往往延迟。
我们报告一例30岁女性患者，她突然出现直肠出血和严重腹痛。经多普勒超声检查发现肠系膜上静脉血栓形成。腹部增强CT检查发现右门静脉血栓形成；使用依诺肝素钠治疗但无改善。随后进行了结肠镜检查；结果显示降结肠远端和乙状结肠近端有缺血性改变。在腹腔镜手术中，切除了缺血部分。两周后的随访中，患者仍在使用依诺肝素钠（每日两次，每次80毫克），总体状况良好。
门静脉血栓形成（PVT）和肠系膜上静脉血栓形成（MVT）是静脉血栓形成的罕见形式且情况不常见。与激素避孕和PCOS相关的肠系膜上静脉血栓形成并不常见。据我们所知，我们在此报告首例与肠系膜上静脉血栓形成相关的急性肠缺血的多囊卵巢综合征病例。
除了多囊卵巢综合征与联合使用避孕药之间的关联外，未发现门静脉血栓形成的诱发因素。我们的病例报告表明，临床医生需要考虑患有多囊卵巢疾病且出现急性腹痛和非典型血栓形成部位的患者发生急性肠缺血的可能性。
