Korean J Gastroenterol.  2021 Jun;77(6):294-299. 10.4166/kjg.2021.014.

Small Bowel Necrosis Associated with Catastrophic Antiphospholipid Syndrome: A Case Report

• Lee HA
• Kim SE
• Jung DW
• Byeon JR
• Choe AR
• Tae CH
• Moon CM
• Jung HK
• Shim KN
• Jung SA

• KMID: 2516890
• DOI: http://doi.org/10.4166/kjg.2021.014

Abstract

Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient’s condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.

Keyword

Catastrophic antiphospholipid syndrome; Mesenteric ischemia; Intestine; small; Surgical procedure; Enterocolitis

Figure

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  Fig. 1 Sigmoidoscopic examination. (A) Mucosal edema with (B) focal hyperemic changes in the sigmoid and rectal colon.

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  Fig. 2 Contrast-enhanced computed tomography of the abdomen. (A) Multiple thrombi (arrows; (1) main portal vein, (2) superior mesenteric artery, (3) abdominal aorta) and (B) segmental dilated small bowel loops with wall thickening and ischemia (arrow).

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  Fig. 3 Gross appearance of a resected necrotic jejunum with no disappearance of mucosal folds or color change. A subtle ischemic change was predicted.

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  Fig. 4 Pathology findings. Hematoxylin-eosin (H&E) staining revealed (A) the serosal infiltration of inflammatory cells (arrow); serositis (H&E, ×100). (B) Ischemic necrosis of the mucosae (H&E, ×100). (C) Thrombosis of small vessels in the small bowel mesentery (black arrow) and congestion (white arrows) (H&E, ×40).

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