Aortoiliac thrombi in inflammatory bowel disease

Area of Science:

• Vascular Surgery
• Gastroenterology
• Hematology

Background:

• Inflammatory bowel disease (IBD) is associated with an increased risk of thromboembolic events.
• Arterial thrombosis is an uncommon complication of IBD, particularly isolated thrombi in major arteries.
• Crohn disease, a subset of IBD, can present with diverse extraintestinal manifestations.

Observation:

• A 28-year-old male with known Crohn disease presented with acute abdominal pain and severe lower limb claudication.
• Imaging revealed an isolated thrombus occluding the aortoiliac segment.
• The patient underwent bilateral aortoiliac thromboembolectomies, achieving successful restoration of arterial blood flow.

Findings:

• Despite extensive hypercoagulable workup, no underlying etiology for the coagulopathy was identified.
• The patient was initiated on long-term anticoagulation therapy for the unexplained arterial thrombosis.
• This case underscores the potential for rare, severe vascular complications in Crohn disease.

Implications:

• This case emphasizes the need for heightened clinical suspicion for arterial thrombosis in IBD patients presenting with suggestive symptoms.
• Early surgical intervention and appropriate anticoagulation are vital for limb salvage and preventing further embolic events.
• Further research into the mechanisms linking IBD and arterial thrombosis may improve risk stratification and treatment strategies.