Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature
Identifieur interne : 000375 ( Main/Exploration ); précédent : 000374; suivant : 000376Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature
Auteurs : Aris Giannos [Grèce] ; Sofoklis Stavrou [Grèce] ; Nikolaos Goumalatsos [Grèce] ; George Fragkoulidis [Grèce] ; Eleni Chra [Grèce] ; Dimitrios Argiropoulos [Grèce] ; Dimitrios Loutradis [Grèce] ; Peter Drakakis [Grèce]Source :
- Journal of Medical Case Reports [ 1752-1947 ] ; 2017.
Abstract
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.
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DOI: 10.1186/s13256-017-1320-5
PubMed: 28683785
PubMed Central: 5501070
Affiliations:
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Sofias Ave, 11528 Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Drakakis, Peter" sort="Drakakis, Peter" uniqKey="Drakakis P" first="Peter" last="Drakakis">Peter Drakakis</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2155 0800</institution-id><institution-id institution-id-type="GRID">grid.5216.0</institution-id><institution>1st OB/GYN Department, School of Medicine,</institution><institution>National and Kapodistrian University of Athens, Alexandra Hospital,</institution></institution-wrap>Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Lourou and Vasilissis Sofias Ave, 11528 Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author></analytic><series><title level="j">Journal of Medical Case Reports</title><idno type="eISSN">1752-1947</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">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.</p></sec><sec><title>Case presentation</title><p id="Par2">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.</p></sec><sec><title>Conclusions</title><p id="Par3">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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Huis, M" uniqKey="Huis M">M Huis</name></author><author><name sortKey="Balija, M" uniqKey="Balija M">M Balija</name></author><author><name sortKey="Lez, C" uniqKey="Lez C">C Lez</name></author><author><name sortKey="Szerda, F" uniqKey="Szerda F">F Szerda</name></author><author><name sortKey="Stulhofer, M" uniqKey="Stulhofer M">M Stulhofer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Mulhim, Aa" uniqKey="Al Mulhim A">AA Al-Mulhim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sudiono, Dr" uniqKey="Sudiono D">DR Sudiono</name></author><author><name sortKey="Ponten, Jb" uniqKey="Ponten J">JB Ponten</name></author><author><name 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M">M Sönmezer</name></author><author><name sortKey="Aytac, R" uniqKey="Aytac R">R Aytaç</name></author><author><name sortKey="Demirel, Lc" uniqKey="Demirel L">LC Demirel</name></author><author><name sortKey="Kurtay, G" uniqKey="Kurtay G">G Kurtay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Atakan Al, R" uniqKey="Atakan Al R">R Atakan Al</name></author><author><name sortKey="Borekci, B" uniqKey="Borekci B">B Borekci</name></author><author><name sortKey="Ozturk, G" uniqKey="Ozturk G">G Ozturk</name></author><author><name sortKey="Akcay, Mn" uniqKey="Akcay M">MN Akcay</name></author><author><name sortKey="Kadanali, S" uniqKey="Kadanali S">S Kadanali</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Grèce</li></country><region><li>Attique (région)</li></region><settlement><li>Athènes</li></settlement></list><tree><country name="Grèce"><region name="Attique (région)"><name sortKey="Giannos, Aris" sort="Giannos, Aris" uniqKey="Giannos A" first="Aris" last="Giannos">Aris Giannos</name></region><name sortKey="Argiropoulos, Dimitrios" sort="Argiropoulos, Dimitrios" uniqKey="Argiropoulos D" first="Dimitrios" last="Argiropoulos">Dimitrios Argiropoulos</name><name sortKey="Chra, Eleni" sort="Chra, Eleni" uniqKey="Chra E" first="Eleni" last="Chra">Eleni Chra</name><name sortKey="Drakakis, Peter" sort="Drakakis, Peter" uniqKey="Drakakis P" first="Peter" last="Drakakis">Peter Drakakis</name><name sortKey="Fragkoulidis, George" sort="Fragkoulidis, George" uniqKey="Fragkoulidis G" first="George" last="Fragkoulidis">George Fragkoulidis</name><name sortKey="Goumalatsos, Nikolaos" sort="Goumalatsos, Nikolaos" uniqKey="Goumalatsos N" first="Nikolaos" last="Goumalatsos">Nikolaos Goumalatsos</name><name sortKey="Loutradis, Dimitrios" sort="Loutradis, Dimitrios" uniqKey="Loutradis D" first="Dimitrios" last="Loutradis">Dimitrios Loutradis</name><name sortKey="Stavrou, Sofoklis" sort="Stavrou, Sofoklis" uniqKey="Stavrou S" first="Sofoklis" last="Stavrou">Sofoklis Stavrou</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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