title: Thrombosis of the superior mesenteric vein in association with hormonal contraceptive use. A case report and review of the literature.
abstract: BACKGROUND
  There are a number of reports in the literature which describe the association of venous thrombosis with oral contraceptives. Venous thrombosis is a rare form of mesenteric ischemia which may be lethal if not diagnosed and treated quickly. Although the non specificity of clinical signs do not always permit an early diagnosis.
  
  
  METHODS
  The patient, aged 52, with a case history characterized by alteration of the alvus with occasional emission of blood, and abdominal pain. She referred with metrorrhagia of about one year, and was being treated with Ethynylestradiol/Gestodene. A CAT scan with contrast showed the signs of thrombosis in the superior mesenteric vein. The patient underwent surgical laparotomy. On opening the peritoneum we found a large tumefaction formed of conglobate iliac loops together with intense inflammation. A resection of the tumefaction was performed "en bloc".
  
  
  CONCLUSIONS
  Pharmacological contraception remains in various cases as the only identified risk factor and there are reports which also censure a relationship of greater risk with increased hormonal doses and even reports of mesenteric venous thrombosis in patients taking triphasic drugs. Thus, we may state with near certainty, that a relationship between pharmacological contraceptives and mesenteric venous thrombosis exists and is probably more than a simple risk factor in contrast to that which exists for tobacco smoking and obesity.
  
  
  CONCLUSIONS
  Before the prescription of contraceptive therapy the examination of risk factors is necessary, compiled preferably by hematochemical screening to exclude haematological and/or coagulative pathologies, and not deriding the use of non-pharmalogical methods of contraception when possible. Considering the technological advancement of instrumentation (CAT scan, angiogram), even a diagnosis aimed at a suspected clinical history; starting from less invasive screening by ultrasonographic Doppler, might induce to a rapid intervention and thereby avoid sacrificing too much intestinal tissue if it is the case.
authors.affiliation: Department of Emergency Surgery, II University of Naples, Italy. adelmo.gubitosi@unina2.it
authors.forename: Adelmo
authors.initials: A
authors.lastname: Gubitosi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Roberto
authors.initials: R
authors.lastname: Ruggiero
authors.forename: Franceso
authors.initials: F
authors.lastname: Esposito
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Foroni
authors.forename: Massimo
authors.initials: M
authors.lastname: Agresti
mesh_terms: D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008642:Mesenteric Veins; D008875:Middle Aged; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D003278:Contraceptives, Oral, Hormonal