COMPLICATED VENOUS MESENTERIC ISCHEMIA: A CASE REPORT

Yüyen İ. E., Ercan L. D., Ercan C. C., Sakcı E., Dölen Burak D., Gök A. F. K., ...Daha Fazla

XII. Congress of the World Society of Emergency Surgery, Antalya, Türkiye, 21 - 25 Ekim 2025, ss.93-94, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.93-94
  • İstanbul Üniversitesi Adresli: Evet

Özet

Background: Heparin-induced thrombocytopenia (HIT) is a transient, immune-mediated, acquired syndrome characterized by platelet activation, consumption, thrombocytopenia, and thromboembolism following heparin exposure. Early recognition is crucial to prevent life- threatening complications.

Case Presentation: A 51-year-old woman underwent left total knee arthroplasty for gonarthrosis and was discharged with a prescription for low-molecular-weight heparin (LMWH) prophylaxis, which she did not take. On postoperative day 18, she presented with abdominal pain and vomiting. CT revealed bilateral pulmonary emboli, left femoral vein thrombosis, portal vein thrombosis, and superior mesenteric vein thrombosis. She underwent diagnostic laparoscopy, exploratory laparotomy, segmental small bowel resection, and functional end-to-end anastomosis. LMWH was initiated preoperatively. On postoperative day 2, platelet count decreased to 41,000/µL. The HIT score indicated low risk initially, but the patient’s platelet count remained low and she subsequently developed acute neurological deterioration. Cranial CT revealed a large right temporal intracerebral hematoma with midline shift. Neurosurgery performed decompressive craniectomy and hematoma evacuation. Due to high suspicion for HIT, LMWH was discontinued and a new oral anticoagulant (rivaroxaban) was initiated once platelet count improved. An inferior vena cava filter was placed during the period without anticoagulation. The patient was discharged in good condition.

Conclusion: This case highlights the importance of early recognition of HIT in postoperative patients receiving heparin therapy. Delayed diagnosis can lead to catastrophic complications including multi-site thrombosis and intracerebral hemorrhage. Early discontinuation of heparin and initiation of alternative anticoagulation are critical for patient outcomes.

Keywords: Venous Mesenteric Ischemia, HIT