Segmental small bowel necrosis associated with antiphospholipid syndrome: A case report

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.