Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4096-4100
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4096
Segmental small bowel necrosis associated with antiphospholipid syndrome: A case report
Qun-Ying Wang, Xiao-Hua Ye, Jin Ding, Xiao-Kang Wu
Qun-Ying Wang, Xiao-Hua Ye, Jin Ding, Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
Xiao-Kang Wu, Department of Hepato-Biliary-Pancreatic Surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
Author contributions: Wang QY and Ding J collected the data; Wu XK performed the surgery and coordinated the study; and Ye XH designed the study and drafted the manuscript.
Ethics approval: This study was approved by the ethical review committee of Jinhua Municipal Central Hospital.
Informed consent: Written informed consent was obtained from the patient’s relatives.
Conflict-of-interest: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Hua Ye, MD, Department of Gastroenterology and Hepatology, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Mingyue Road No. 351, Jinhua 321000, Zhejiang Province, China. yexiaohuare@qq.com
Telephone: +86-579-82552766 Fax: +86-579-82552765
Received: September 7, 2014
Peer-review started: September 7, 2014
First decision: October 29, 2014
Revised: December 19, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 7, 2015
Processing time: 212 Days and 16.6 Hours
Abstract

Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid (anticardiolipin IgM) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient’s condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

Keywords: Anticardiolipin antibodies; Antiphospholipid syndrome; Intestinal necrosis; Mesenteric arteriolar thrombosis; Small bowel obstruction

Core tip: Antiphospholipid syndrome is a multi-organ disease characterized by the presence of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. This case report demonstrates that antiphospholipid syndrome should be suspected for cases of unexplainable ischemic bowel and intestinal necrosis with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to amelioration of the disease course.