Case Report Open Access

Concurrent Factor V Leiden Mutation and Antithrombin III Deficiency in Presenting as Mesenteric Venous Thrombosis and Small Bowel Gangrene

Abstract

Case report of a young adult male in whom a rare hypercoagulable state - Factor V Leiden heterozygous mutation and concurrent Antithrombin III deficiency predisposed to Mesenteric venous thrombosis and consequent small bowel gangrene. The case is reported in view of its rarity and to emphasize the importance of detecting such prothrombotic disorders at an early stage to prevent or minimize such morbidities. A 30 year old male of Lebanese nationality presented with symptoms of acute abdomen. CT angiogram of the abdomen was done, showing suspected mesenteric ischemia and superior mesenteric vein thrombosis. Emergency Laparotomy was performed; segmental resection of small intestine including part of jejunum and ileum was done comprising of two gangrenous segments each around 15 cm and intervening viable segment, followed by primary anastomosis. Gross and microscopic examination showed extensive coagulative necrosis involving distal jejunum, part of ileum, edema of bowel wall and venous thrombosis involving intramural and mesenteric veins. Further diagnostic workup revealed Factor V Leiden Heterozygous mutation and Antithrombin III deficiency. The patient was anticoagulated initially with unfractionated heparin then enoxaparin and subsequently on Warfarin targeting INR of 2 to 3, with close monitoring of INR and has recovered well, presently doing fine 1 year post-surgery Venous thrombosis associated with hereditary hypercoagulable states and consequent bowel ischemia is a rare but potentially life threatening condition. Recognition of predisposing conditions by screening strategies, especially in susceptible populations could prevent such eventualities.

Thomas A, Abdallah D, Shakir W and Krishnan K*

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