Ahmed K, Darakhshan A, Au E, Khamashta MA, Katsoulis IE. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome. World J Gastroenterol 2009; 15(4): 502-505 [PMID: 19152458 DOI: 10.3748/wjg.15.502]
Corresponding Author of This Article
Iraklis E Katsoulis, MD, PhD, Consultant Surgeon, Department of Surgery, St. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom. hrkats@yahoo.co.uk
Article-Type of This Article
Case Report
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World J Gastroenterol. Jan 28, 2009; 15(4): 502-505 Published online Jan 28, 2009. doi: 10.3748/wjg.15.502
Postpartum spontaneous colonic perforation due to antiphospholipid syndrome
Kamran Ahmed, Amir Darakhshan, Eleanor Au, Munther A Khamashta, Iraklis E Katsoulis
Kamran Ahmed, Department of Biosurgery and Surgical Technology, Imperial College, London W2 1NY, United Kingdom
Amir Darakhshan, Eleanor Au, Iraklis E Katsoulis, Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
Munther A Khamashta, Lupus Unit, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
Author contributions: Ahmed K carried out the design of the study, acquired patient’s records, and drafted the manuscript; Darakhshan A participated in acquisition of data; Au E partici-pated in acquisition of data; Khamashta MA participated in acquisition of data and added specialist opinion about the lupus/medical aspect of this study; Katsoulis IE carried out the design of the study, coordinated the study, and drafted the manuscript.
Correspondence to: Iraklis E Katsoulis, MD, PhD, Consultant Surgeon, Department of Surgery, St. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom. hrkats@yahoo.co.uk
Telephone: +44-20-71882569
Fax: +44-20-71881547
Received: February 20, 2008 Revised: May 13, 2008 Published online: January 28, 2009
Abstract
The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea, and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed. The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin. Eventually, she made a full recovery and had her stoma reversed after 4 mo. Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care. This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as pre-eclampsia and placental insufficiency.
