Nonsurgical Management of Postpartum Arterial Mesenteric Thrombosis: An Exceptional Outcome

Acute arterial mesenteric ischemia is exceptional in the postpartum period, and the few published cases mainly describe proximal occlusions of the superior mesenteric artery with a poor prognosis.We report the case of a 37-year-old woman with hypertensive nephropathy and chronic kidney disease who underwent cesarean delivery at 38 weeks of gestation for superimposed preeclampsia.On postpartum day 15, eight days after discontinuation of enoxaparin thromboprophylaxis, she presented with sudden abdominal pain out of proportion to the physical findings, severe high anion gap metabolic acidosis, and acute-on-chronic kidney injury (creatinine clearance 18.7 mL/min).Computed tomography angiography showed partially occlusive filling defects in distal segmental branches of the superior mesenteric artery, with a patent main trunk and preserved bowel wall enhancement.After surgical consultation, conservative management was undertaken in the intensive care unit with intravenous unfractionated heparin, aspirin, correction of metabolic disturbances, and close monitoring against predefined criteria for surgical conversion.Control angiography on day eight of treatment was normal.Treatment was switched to reduced-dose apixaban plus aspirin.The etiological workup revealed isolated anti-SSA/Ro52 antibodies without evidence of lupus and could not formally exclude antiphospholipid syndrome.No recurrence or bleeding occurred during eight months of follow-up.This case suggests that early computed tomography angiography, performed despite renal impairment, can identify distal, pre-necrotic arterial lesions that may be managed conservatively under close surveillance in carefully selected patients.