We here present a case of diverticulitis complicated by a pylephlebitis of the portal and superior mesenteric vein, requiring treatment with heparin and antibiotics. The patient subsequently developed a splenic vein thrombosis and suffering bowels. A large resection of the small bowel was performed, with subsequent ileostomy and parenteral nutrition. Following anticoagulation therapy initiation, a thrombocytopenia was observed, and the patient was found to have developed heparin-induced thrombocytopenia (HIT), as evidenced by high levels of anti-heparin/PF4 antibodies. Furthermore, he had a contributory family history of thrombophilia, and molecular tests confirmed that he was carrying a thrombophilic G20210A factor II mutation. To our knowledge, this is the first case report of a bowel ischemia in a context of pylephlebitis treated with heparin, leading to another rare thrombophilic syndrome: heparin-induced thrombocytopenia and thrombophilia (HITT).
This article illustrates how a rare complication of a common disease and its treatment can aggravate the primary condition. We discussed the pylephlebitis and the HITT as the explanation for such a rare consequence on the bowel in the context of inherited thrombophilia.
Pylephlebitis, heparin-induced thrombocytopenia, surgery, bowel ischemia, prothrombin mutation
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