上腸間膜動脈血栓症にて発見された本態性血小板血症の１例

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  • A Case of Superior Mesenteric Artery Thrombosis Based on Essential Thrombocythemia

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A 78-year-old man visited our hospital with a complaint of left hypochondralgia. He had hit his abdomen a month previously and pain had gradually worsened. Although his white blood cell and platelet counts were high (29, 900/mm3 and 560, 000/mm3), his general condition was stable. We treated him conservatively. Four days later, he presented symptoms and signs of peritonitis, and emergency surgery was performed. Thrombi were found in three ileal branches of the superior mesenteric artery (SMA). The necrotic ileum (150cm) was surgically resected and the residual ileum was anastomosed in an end-to-end fashion. Based on his platelet count, which was>1, 000, 000/mm3 after surgery, and bone marrow findings, he was diagnosed as havinge essential thrombocythemia. The most known causes of SMA occlusion are atrial fibrillation and atherosclerosis, which were absent in this patient. We believed that in this patient thrombosis was related to essential thrombocythemia and inflammation of the mesentery due to abdominal trauma. Thrombocytosis is usually seen as a reactive change with inflammation. But it can also be seen in myeloproliferative disorders. In the perioperative period, treatments with aspirin or hydroxyurea and platelet apheresis should be considered, to prevent thrombosis and bleeding.

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