Combined Intestinal Ischemia, Cerebral Stroke and Thrombosis of Thoracoabdominal Aorta and Splenic Artery in a Thrombophilic Woman: A Case Report

Aim: To present an uncommon, life-threatening case of intestinal ischemia complicated by cerebral stroke, thoraco-abdominal aorta and splenic artery thrombosis, in a woman with thrombophilia presenting common clinical signs.

Presentation of Case: A 42-year-old woman was admitted to hospital for lower abdominal pain, vomiting and fever. Emergency abdominal surgery evidenced intestinal ischemia requiring 80 cm ileum resection. The day following surgery, the patient lost consciousness and was admitted to the stroke unit. Thereafter, the patient was transferred to the intensive care unit due to respiratory failure. A brain-thoracic-abdominal CT-angiography showed occlusion of left medium cerebral artery, a thrombotic formation in thoracic and abdominal aorta, and partial occlusion of splenic artery. Homocysteine levels were 56.8mmol/l, screening for homozygosis mutation MTHFRC677T positive. Resolution of systemic thrombosis lasted one month. Patient was finally transferred to a rehabilitation center.

Discussion: Vascular disease and ischemic stroke have rarely been reported in subjects with thrombophilia and MTHFR polymorphisms. Our patient, affected by thrombophilia and high homocysteine levels, faced multiple vascular and cerebral complications. High concentration of homocysteine, with consequent vessel deposits, was detrimental for endothelium and vessel walls, due to action on blood coagulation factors and lipoproteins, with increased platelet adhesion and aggregation.

Conclusion: This case report represents an uncommon, sudden, life-threatening complication in thrombophilic patients, in spite of the common clinical signs presented. This clinical report should alert physicians to the importance of carrying out a careful clinical examination in the presence of thrombophilic patients presenting with apparently common clinical signs, such as abdominal pain, vomiting and fever.