Mesenteric Artery Occlusion Secondary to Activated Protein C Resistance

We present a case of mesenteric ischemia in a 32-year-old woman. The rarity of this potentially fatal condition in this age group, the diagnostic and therapeutic challenges associated with such a condition, and secondary causes that must always be investigated are highlighted. In this case, activated protein C resistance resulted in thrombosis of the superior mesenteric artery and subsequent bowel ischemia. Mesenteric ischemia, first defined by Virchow in 1852, is a condition predominantly affecting the elderly (mean age 76 years), often in asso-ciation with concomitant peripheral vascular and coronary artery disease, and has rarely been described in the young.1 Despite techno-logical advances in diagnostic imaging and therapeutic modalities, the mortality from this condition remains high. Early diagnosis and surgical management is crucial. However, in a condition where early symptoms and signs are nonspecific, the diagnosis is often difficult and dependent on a low threshold for investigation. We describe a case of mesenteric arterial ischemia in a 32-year-old woman secondary to activated protein C (APC) resistance. APC resistance normally affects the venous system,2 and to date, there has been only 1 reported case of mesenteric arterial ischemia secondary to this condition.