Successful outcome of multiple arterial embolisation in a 16-year-old girl with ulcerative colitis

Introduction: Though thromboembolic events are known to complicate inflammatory bowel disease very few cases with arterial occlusion have been reported in pediatric ulcerative colitis (UC) so far.

Report: A 16-year-old female patient who had been treated for UC (descending colon and rectosigmoid localization) for 2 years was admitted because of a flare-up (PUCAI=70). Lab tests and abdominal ultrasound were consistent with the clinical picture. Stool culture proved giardia infestation. On 48mg methylprednisolon and metronidazole her condition improved, bloody diarrhoea ceased. On day 14 her condition deteriorated, she developed preshock and severe chest pain. Chest X-ray and cardiology exam showed no abnormality. No evidence of coagulopathy could be demonstrated. After fluid resuscitation, packed red blood cell transfusion and further elevation of her corticosteroid (3mg/kg/day) her symptoms resolved. Ten days later she developed clinical signs of arterial circulatory defect of her left leg. As Doppler scan showed no signs of arterial occlusion vascular surgeon suspected vasospastic syndrome. Low molecular weight heparin and pentoxifylline were given, her symptoms resolved by next day. Two days later she had a transient motor aphasia that resolved without sequelae in 30 minutes completely. Few hours later she developed left femoral artery occlusion and femoral embolectomy was performed. Head MRI showed signs of bilateral multiple microembolisation. Repeated cardiology exam demonstrated neither cardiac anomaly nor intracardiac source of emboli. Screening for factor V Leiden and prothrombin mutations was negative and antiphospholipid syndrome could be excluded also. Family history was negative for thromboembolic episodes. At present the patient is in remission without any rest symptoms of her previous emboli.

Discussion: Arterial embolisation in UC is extremely uncommon. In our patient none of the tests revealed any predisposing factors therefore we consider UC as the most likely trigger for hypercoagulability causing arterial embolisations.