High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome
Diverting stoma (DS) is widely created in colorectal surgery. High-output stoma (HOS) is a major complication of DS, which can lead to dehydration and thrombosis. Additionally, antiphospholipid syndrome (APS) is a risk factor for thrombosis, and it rarely occurs in men. Herein, we describe a case of...
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| Format: | Article |
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Karger Publishers
2022-06-01
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| Series: | Case Reports in Gastroenterology |
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| Online Access: | https://www.karger.com/Article/FullText/525297 |
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| author | Sho Ishikawa Shoichiro Mukai Hiroyuki Sawada Yasufumi Saito Masahiko Fujimori Yuzo Hirata Toshikatsu Fukuda Hideto Sakimoto Hirofumi Nakatsuka Hideki Ohdan |
| author_facet | Sho Ishikawa Shoichiro Mukai Hiroyuki Sawada Yasufumi Saito Masahiko Fujimori Yuzo Hirata Toshikatsu Fukuda Hideto Sakimoto Hirofumi Nakatsuka Hideki Ohdan |
| author_sort | Sho Ishikawa |
| collection | DOAJ |
| description | Diverting stoma (DS) is widely created in colorectal surgery. High-output stoma (HOS) is a major complication of DS, which can lead to dehydration and thrombosis. Additionally, antiphospholipid syndrome (APS) is a risk factor for thrombosis, and it rarely occurs in men. Herein, we describe a case of multiple thromboses caused by chronic dehydration after HOS. A 48-year-old man visited our hospital with fever and lower abdominal pain; he was diagnosed with sigmoid diverticulitis. He underwent laparoscopic high anterior resection for relapsing diverticulitis and diverting ileostomy during the same operation. On postoperative day 1, an output of 3,000 mL/day was observed from the ileostomy. The stoma output exceeded 2,000 mL/day, which was diagnosed as HOS, and chronic dehydration persisted despite supplementation and restriction of oral water intake. Three months postoperatively, a computed tomography scan before ileostomy closure showed multiple thrombi in the inferior vena cava, right common iliac vein, and pulmonary artery. After antithrombotic therapy, ileostomy closure was performed. As lupus anticoagulant was positive twice and APS was diagnosed, antithrombotic therapy was changed from warfarin to direct oral anticoagulants. Thrombosis did not recur 6 months postoperatively. This is the first report of a case wherein APS was present in the background of thrombosis caused by HOS or chronic dehydration. It is important to be cautious about APS when there is thrombosis after HOS to select appropriate therapeutic agents. |
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| id | doaj.art-a7b977d80a1e4b80b8e715d2d468d04e |
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| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-12-12T00:13:50Z |
| publishDate | 2022-06-01 |
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| series | Case Reports in Gastroenterology |
| spelling | doaj.art-a7b977d80a1e4b80b8e715d2d468d04e2022-12-22T00:44:53ZengKarger PublishersCase Reports in Gastroenterology1662-06312022-06-0116241842410.1159/000525297525297High-Output Stoma Leading to the Diagnosis of Antiphospholipid SyndromeSho Ishikawa0Shoichiro Mukai1https://orcid.org/0000-0002-1883-0454Hiroyuki Sawada2Yasufumi Saito3Masahiko Fujimori4Yuzo Hirata5Toshikatsu Fukuda6Hideto Sakimoto7Hirofumi Nakatsuka8Hideki Ohdan9Department of Surgery, Kure City Medical Association Hospital, Kure, JapanDepartment of Gastroenterological Surgery, Chugoku Rosai Hospital, Kure, JapanDepartment of Gastroenterological Surgery, Saiseikai Hiroshima Hospital, Hiroshima, JapanDepartment of Gastroenterological Surgery, Chugoku Rosai Hospital, Kure, JapanDepartment of Surgery, Kure City Medical Association Hospital, Kure, JapanDepartment of Gastroenterological Surgery, Saiseikai Hiroshima Hospital, Hiroshima, JapanDepartment of Gastroenterological Surgery, Chugoku Rosai Hospital, Kure, JapanDepartment of Surgery, Kure City Medical Association Hospital, Kure, JapanDepartment of Surgery, Kure City Medical Association Hospital, Kure, JapanDepartment of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JapanDiverting stoma (DS) is widely created in colorectal surgery. High-output stoma (HOS) is a major complication of DS, which can lead to dehydration and thrombosis. Additionally, antiphospholipid syndrome (APS) is a risk factor for thrombosis, and it rarely occurs in men. Herein, we describe a case of multiple thromboses caused by chronic dehydration after HOS. A 48-year-old man visited our hospital with fever and lower abdominal pain; he was diagnosed with sigmoid diverticulitis. He underwent laparoscopic high anterior resection for relapsing diverticulitis and diverting ileostomy during the same operation. On postoperative day 1, an output of 3,000 mL/day was observed from the ileostomy. The stoma output exceeded 2,000 mL/day, which was diagnosed as HOS, and chronic dehydration persisted despite supplementation and restriction of oral water intake. Three months postoperatively, a computed tomography scan before ileostomy closure showed multiple thrombi in the inferior vena cava, right common iliac vein, and pulmonary artery. After antithrombotic therapy, ileostomy closure was performed. As lupus anticoagulant was positive twice and APS was diagnosed, antithrombotic therapy was changed from warfarin to direct oral anticoagulants. Thrombosis did not recur 6 months postoperatively. This is the first report of a case wherein APS was present in the background of thrombosis caused by HOS or chronic dehydration. It is important to be cautious about APS when there is thrombosis after HOS to select appropriate therapeutic agents.https://www.karger.com/Article/FullText/525297high-output stomadiverting ileostomyantiphospholipid syndromethrombosis |
| spellingShingle | Sho Ishikawa Shoichiro Mukai Hiroyuki Sawada Yasufumi Saito Masahiko Fujimori Yuzo Hirata Toshikatsu Fukuda Hideto Sakimoto Hirofumi Nakatsuka Hideki Ohdan High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome Case Reports in Gastroenterology high-output stoma diverting ileostomy antiphospholipid syndrome thrombosis |
| title | High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome |
| title_full | High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome |
| title_fullStr | High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome |
| title_full_unstemmed | High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome |
| title_short | High-Output Stoma Leading to the Diagnosis of Antiphospholipid Syndrome |
| title_sort | high output stoma leading to the diagnosis of antiphospholipid syndrome |
| topic | high-output stoma diverting ileostomy antiphospholipid syndrome thrombosis |
| url | https://www.karger.com/Article/FullText/525297 |
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