Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Case Report

Volume 15, Number 2, April 2022, pages 100-105


Extensive Aortic Thrombosis and Renal Infarction in Association With an Active Flare-Up of Crohn’s Disease

Figures

Figure 1.
Figure 1. Axial image of contrast-enhanced computed tomography of abdomen with an active flare-up of Crohn’s disease showing a localized perforation at the distal ileum (horizontal red arrow).
Figure 2.
Figure 2. Sagittal (a) and axial (b) image of contrast-enhanced computed tomography of abdomen showing a large thrombus at the distal descending aorta (horizontal arrow).
Figure 3.
Figure 3. Axial image (a) and sagittal image (b) of contrast-enhanced CT abdomen showing a left renal infarct (arrows).

Table

Table 1. Summary of Cases of IBD-Associated Aortic Mural Thrombosis
 
Authors/publication yearPatient’s age (years)/genderIBD/activity statusAortic thrombosis site/embolus site/clinical consequencesManagementOutcome
IBD: inflammatory bowel disease; CD: Crohn’s disease; IMA: inferior mesenteric artery; SMA: superior mesenteric artery; UC: ulcerative colitis; IR: interventional radiology.
Novacek et al, 2004 [3]36/femaleUC/activeDistal abdominal aorta with occlusion of the origin of IMA with distal colonic spare due to SMA collateralsMedical management of UC. Heparin anticoagulation followed by a direct oral anticoagulantGood outcome with thrombus resolution
Novacek et al, 2004 [3]41/femaleCD/activeDistal abdominal aorta with left iliac embolization and acute left lower extremity ischemiaThrombectomy with heparin anticoagulation followed by a coumarin derivativeLeft leg amputation. Thrombus resolution
Khan et al, 2009 [5]41/maleCD/active (post-operative)Extensive proximal abdominal aorta occluding the ostia of celiac, SMA, and left renal artery with left renal infarction and diffuse small bowel and colonic ischemia. Aortic arch thrombusHeparin anticoagulation with failed IR attempts to cannulate blocked visceral and mesenteric vesselsDeath from visceral ischemia and sepsis
Kok et al, 2012 [6]48/femaleUC/activeLarge proximal abdominal aorta thrombus with splenic artery embolization and splenic infarctionHeparin anticoagulation followed by warfarinGood outcome
Talbot et al,1986 [7]47/maleCD/activeInfra-renal abdominal aorta with colonic ischemiaUnspecifiedDeath due to colonic ischemia
Perler et al, 1991 [8]34/femaleCD/unspecifiedInfra-renal abdominal aorta with distal embolizationThrombo-embolectomy with heparin anticoagulationGood outcome
Novotny et al, 1992 [9]35/femaleUC/unspecifiedAorto-iliac thrombosisUnspecifiedLeg amputation
Novotny et al, 1992 [9]22/femaleUC/unspecifiedAorto-bifemoral thrombosisUnspecifiedUnspecified
Novotny et al, 1992 [9]34/femaleUC/unspecifiedAorto-iliac thrombosisThrombectomy with heparin anticoagulationGood outcome
Hahn et al, 1999 [10]34/maleCD/active (post-operative)Infra-renal abdominal aorta with distal embolization resulting in blue toe syndromeLower extremity embolectomy with heparin anticoagulation followed by warfarinGood outcome with thrombus resolution
Hahn et al, 1999 [10]74/maleCD/active (post-operative)Peripancreatic aorta with severe pancreatitis and distal embolization with blue toe syndromeHeparin anticoagulation followed by warfarinToe amputation. Thrombus resolution
Lehmann et al, 2001 [11]50/femaleCD/activeInfra-renal abdominal aorta with distal embolization to the right popliteal artery resulting in acute lower extremity ischemiaThrombolysis with urokinase then lower extremity embolectomy with heparin anticoagulation followed by warfarinGood outcome
Szychta et al, 2001 [12]42/femaleUC/activeInfra-renal abdominal aorta with right renal artery embolization with a right renal infarctionRenal thrombectomy with heparin anticoagulation followed by a coumarin derivativeGood outcome
Grothues et al, 2002 [13]49/maleUC/activeAortic arch thrombus in a critically ill UC patient with systemic aspergillosis infectionUC management with antifungal therapyDeath from systemic sepsis
Delay et al, 2014 [14]33/femaleCD/quiescentExtensive infra-renal abdominal aortic thrombosis extending to both iliac arteries. Extensive workup negative for underlying etiologyThe initial IR attempt failed. Aorto-bifemoral bypass with heparin anticoagulation followed by life-long aspirinGood outcome. Histology showed non-specific occlusive aortitis.
Singh et al, 2012 [15]28/femaleCD/activeAortoiliac thrombosis. Saddle aortic thrombus at aortic bifurcation extending to both common iliacBilateral aorto-iliofemoral bypass surgery. Heparin anticoagulation followed by warfarin for six monthsGood outcome with complete thrombus resolution
Elder et al, 2010 [16]40/maleUC/activeAortic arch thrombus with distal lower extremity embolization resulting in acute ischemia of the left lower extremityLimb salvage with embolectomy. Anticoagulation with heparinGood outcome
Leblanc et al, 2011 [17]25/femaleCD/activeAbdominal aorta thrombus with distal embolization to the left popliteal artery and acute ischemia of the left lower extremityEmbolectomy and revascularization surgery with heparin anticoagulationGood outcome
Leblanc et al, 2011 [17]24/femaleCD/activeAbdominal aorta thrombus extending into IMA with distal colon sparing by multiple SMA collateralsHeparin anticoagulationGood outcome with complete thrombus resolution
Sinapi et al, 2010 [18]47/maleUC/activeDistal descending thoracic aorta thrombus and aortic arch thrombusHeparin anticoagulation and medical management for UCGood outcome
Stordiau et al, 2011 [19]56/maleCD/activeAortic arch thrombus with distal embolization to the left subclavian and axillary arteries resulting in acute ischemia of the left upper extremityEmbolectomy, followed by a series of revascularization surgeries and eventually upper extremity amputation. Bowel resection for perforated ileal diseaseAmputation of left upper extremity