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Postpartum Thrombosis of the Superior Mesenteric Artery After Vaginal Delivery

From the Departments of ¹Obstetrics and Gynecology and ⁴Colorectal Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris, Clichy, France; and Departments of ²Internal Medicine, ³Anesthesilogy, and ⁵Vascular and Thoracic Surgery, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France.

ABSTRACT

BACKGROUND: Several causes of severe and acute postpartum abdominal pain (pelvic infection, complications of pelvic thromboembolism, arterial ischemia) require early diagnosis and prompt therapy.

CASE: Eight days after a normal vaginal delivery, a 38-year-old woman presented with severe acute abdominal pain that had been going on for 3 days. Abdominal computed tomography showed a superior mesenteric artery thrombosis with suggested ileal wall ischemia. An emergency thrombectomy associated with ileal resection and ileostomy were performed. No identifiable source of embolism, hemostatic disorder, systemic vasculitis, or systemic disease associated with thrombosis was found.

CONCLUSION: Even after a vaginal delivery, the postpartum period is associated with an increased risk of complications of thromboembolism. In the case of acute abdominal pain, abdominal contrast-enhanced computed tomography may be necessary to exclude mesenteric arterial ischemia.