Ws. Gradman et al., Homocysteine-associated acute mesenteric artery occlusion treated with thrombectomy and bowel resection, ANN VASC S, 15(2), 2001, pp. 247-250
Elevated plasma homocysteine is an acknowledged risk factor for arterioscle
rotic occlusive disease, but little clinical evidence is available regardin
g its role in acute arterial thrombosis in the absence of an underlying les
ion. A 45-year old man presented with an acute abdomen. A magnetic resonanc
e arteriogram (MRA) showed occlusion of the superior mesenteric artery. At
exploration, necrotic ileum was resected and the superior mesenteric artery
was thrombectomized, restoring normal mesenteric flow. The plasma homocyst
eine level was 98.8 mu mol/L, more than eight times the normal level. No em
bolic source was identified and an MRA and contrast arteriogram showed no r
esidual occlusive disease in the superior mesenteric artery. Additional stu
dies documented pernicious anemia, which was treated with cobalamin (vitami
n B,,) injections. This case provides further evidence of an association be
tween hyperhomocysteinemia and acute arterial thrombosis. Hyperhomocysteine
mia can result from easily correctible vitamin B-12, B-6, or dietary folate
deficiencies. Plasma homocysteine levels should be determined in young ind
ividuals with acute arterial thrombosis whenever a hypercoagulable state is
suspected.