Homocysteine-associated acute mesenteric artery occlusion treated with thrombectomy and bowel resection

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.