Severe Mesenteric Ischemia in a Pregnant Woman with Antiphospholipid Syndrome

The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteria include vascular thrombosis of venous, artery, small vessel in any organ, and recurrent pregnancy pathologies. Mesenteric ischemia is a rare and threatening manifestation of APS. We herein report a case of a 34-year-old pregnant woman referred to our Emergency Room with thoracic and abdominal acute pain. Her past medical history was remarkable for positivity to antiphospholipid antibodies, deep vein thrombosis of the right lower limb, chronic occlusion of celiac trunk, and superior mesenteric artery and recurrent abortions. Imaging revealed acute occlusion of inferior mesenteric artery (IMA). Both a surgical and endovascular thrombectomy were ineffective to obtain durable IMA patency and so the patient underwent antegrade aorta-inferior mesenteric bypass with saphenous vein and resection of an ischemic ileal loop. The medical treatment at discharge was lifelong oral anticoagulant associated with double antiplatelet therapy. To the best of our knowledge, this is the first case reporting a young pregnant woman with APS and mesenteric ischemia submitted to several attempts of revascularization. Aggressive oral anticoagulant and antiplatelet long-term therapy is advised. Moreover, we recommend strict follow-up in those patients in order to early diagnose thrombotic recurrence.