Postpartum Superior Mesenteric Vein Thrombosis and Heparin-Induced Thrombocytopenia: Clinical Insights.

Abstract

BACKGROUND Women are at an increased risk of developing venous thrombosis during gestation and the postpartum period, due to physiological and anatomical changes. Superior mesenteric vein thrombosis (SMVT) is a rare and severe complication with a dangerous course and a high mortality rate. Heparin-induced thrombocytopenia (HIT) is also rare in patients treated with heparin and presents with thrombosis and thrombocytopenia. We report a patient with SMVT diagnosis who was treated with heparin anticoagulation after surgery and eventually developed HIT. CASE REPORT The patient was a 30-year-old woman with a diagnosis of SMVT 10 days after giving birth to her second child. She was treated with heparin anticoagulation and interventional catheter-based thrombolysis and thrombectomy, which was ineffective, and she showed peritonitis. We therefore performed an emergency laparotomy, during which we found partial small intestine necrosis and performed a partial small bowel resection. However, the systemic thrombosis worsened postoperatively, and after a multidisciplinary team consultation, HIT was diagnosed. After switching to non-heparin anticoagulation, the patient's condition improved, and she was discharged from the hospital. CONCLUSIONS This is the first case report of HIT secondary to heparin anticoagulation in a parturient who underwent surgery for intestinal necrosis caused by SMVT. Our case highlights the challenge of treating SMVT and the difficulty of diagnosis of HIT. SMVT is a serious condition that requires sufficient experience to judge the timing of surgery. HIT is a rare complication that occurs during heparin use, and its timely diagnosis and treatment have a significant impact on patient prognosis.