Thrombosis of the superior mesenteric vein in association with hormonal contraceptive use. A case report and review of the literature

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COD: 01_2011_69-74 Categorie: ,

Adelmo Gubitosi, Giovanni Docimo, Nicola Avenia, Roberto Ruggiero, Franceso Esposito, Emanuela Esposito, Fabrizio Foroni, Massimo Agresti

Ann. Ital. Chir., 2011 82: 69-74

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INTRODUCTION: There are a number of reports in the literature which describe the association of venous thrombosis with
oral contraceptives. Venous thrombosis is a rare form of mesenteric ischemia which may be lethal if not diagnosed and
treated quickly. Although the non specificity of clinical signs do not always permit an early diagnosis.
MATERIALS AND METHODS: The patient, aged 52, with a case history characterized by alteration of the alvus with occasional
emission of blood, and abdominal pain. She referred with metrorrhagia of about one year, and was being treated
with Ethynylestradiol\Gestodene. A CAT scan with contrast showed the signs of thrombosis in the superior mesenteric
vein. The patient underwent surgical laparotomy. On opening the peritoneum we found a large tumefaction formed of
conglobate iliac loops together with intense inflammation. A resection of the tumefaction was performed “en bloc”.
DISCUSSION: Pharmacological contraception remains in various cases as the only identified risk factor and there are reports
which also censure a relationship of greater risk with increased hormonal doses and even reports of mesenteric venous
thrombosis in patients taking triphasic drugs. Thus, we may state with near certainty, that a relationship between pharmacological
contraceptives and mesenteric venous thrombosis exists and is probably more than a simple risk factor in contrast
to that which exists for tobacco smoking and obesity.
CONCLUSIONS: Before the prescription of contraceptive therapy the examination of risk factors is necessary, compiled preferably
by hematochemical screening to exclude haematological and/or coagulative pathologies, and not deriding the use of
non-pharmalogical methods of contraception when possible. Considering the technological advancement of instrumentation
(CAT scan, angiogram), even a diagnosis aimed at a suspected clinical history, starting from less invasive screening
by ultrasonographic Doppler, might induce to a rapid intervention and thereby avoid sacrificing too much intestinal tissue
if it is the case.