Ercan GEDİK, Sadullah GİRGİN, Senem ŞENTÜRK, İbrahim Halil TAÇYILDIZ, Celalettin KELEŞ

PROTEİN C EKSİKLİĞİNE BAĞLI MEZENTER VEN TROMBOZU: DÖRT OLGU

AMAÇ:Akut mezenter iskemilerinin %5-15'ini mezenter ven trombozları oluşturur. Genellikle mezenter ventrombozu, hiperkoagulasyon bozuklukları ile ilişkilidir ve bir hiperkogulasyon bozukluğu olan Protein Ceksikliği, mezenter ven trombozu oluşumu için önemli bir risk faktörüdür. Bu çalışmada, protein C eksikliğinebağlı mezenter ven trombozu gelişen 4 olguyu inceledik.OLGULAR:Olgularımızın ikisi bayan, ikisi ise erkek olup, ortak hastaneye başvuru şikayetleri karın ağrısı idi.Fizik muayenede 3 olguda akut batın bulguları bulunduğundan laparotomi yapıldı. Nekroze barsaksegmentlerine rezeksiyon yapıldıktan sonra hastalara jejunojejunal anastomoz (olgu 1), uç jejunostomi (olgu 2)ve çifte namlulu enterostomi (olgu 3) yapıldı. İntestinal nekroz bulgusu saptanmayan diğer olguda (olgu 4)mezenter ven trombozu tanısı, batın tomografisi ile konuldu. Bu olguya 5.000 Ü bolus ve 1.000 Ü/ saat olacakşekilde heparin infüzyonu 10 gün süre ile yapıldı. Olguların hiperkoagulabilite testleri yapıldığında protein Cdüzeyi sırası ile %42.20, %38.50 , %35.40 ve %29.25 şeklinde düşük oldukları saptandı. Bütün hastalara düşükmolekül ağırlıklı heparin verildikten sonra warfarin tedavisine geçildi.SONUÇ:Mezenter ven trombozu tanısı konulan hastalarda etiyolojik sebep mutlaka araştırılmalıdır. Protein Ceksikliği mezenter ven trombozu gelişmesi için önemli bir risk faktörüdür. İntestinal nekroz gelişen hastalardalaparotomi yapılmalı ancak intestinal nekroz bulgusu olmayan hastalarda ise nonoperatif tedavi uygulanabilir

Anahtar Kelimeler:

Mezenter ven, tromboz, protein C eksikliği

Mesenteric Venous Thrombosis Due to Protein C Deficiency: Report of Four Cases

OBJECTIVE: Mesenteric venous thrombosis is seen in 5-15% of acute mesenteric ischemia patients. Mesenteric venous thrombosis is generally related to hypercoagulation disorders and proteinCdeficiency, which is a hypercoagulation disorder and one of the important risk factors for mesenteric venous thrombosis development. In this study, we investigated 4 cases of mesenteric venous thrombosis related to protein C deficiency. CASES: Cases included 2 male and 2 female patients and the main symptom was abdominal pain. The patients with physical examination findings of acute abdomen undergone emergency laparotomy. During operation, following resection of necrotic part of bowel; in Case 1, jejunojejunal anastomosis; in Case 2 end jejunostomy and in Case 3 double jejunocolic ostomy were performed. In one patient, mesenteric venous thrombosis was diagnosed by abdominal tomography without any finding of acute abdomen. This patient had 5000 U bolus and 10000 U/h heparin infusions for 10 days. Hypercoagubility tests' results for Protein C levels were as 42.20%, 38.50% , 35.40% and 29.25%, for Cases 1-4, respectively. All patients had low molecular heparin initially then continued with warfarin therapy. CONCLUSION: Etiology of mesenteric venous thrombosis must be investigated in patients diagnosed with mesenteric venous thrombosis. Protein C deficiency is one of the important risk factors of mesenteric venous thrombosis development. Laparotomy is necessary in patients with intestinal necrosis whereas patients without intestinal necrosis might be followed with nonoperative treatment.

Keywords:

Mesenteric ven, thrombosis, protein C deficiency,

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