Porto-spleno-mesenteric thrombosis secondary to medroxyprogesterone acetate as a treatment for abnormal uterine bleeding: a case report

Acute mesenteric venous thrombosis is a rare and potentially lethal cause of intestinal ischemia. We report a 38-year-old woman with abnormal uterine bleeding, with anemia, and prolonged use of medroxyprogesterone acetate. She presented severe abdominal pain, peritoneal signs, and systemic inflammatory response. Computed tomography revealed thrombosis of the portal, splenic, and superior mesenteric veins with jejunal wall thickening. Initial laparotomy showed a viable bowel; full anticoagulation was started. She later developed perforation requiring jejunal resection and subsequent reoperation for anastomotic dehiscence. Extensive workup revealed no prothrombotic disorder other than progestin use. This case highlights the need to consider hormonal agents as potential triggers of porto-spleno-mesenteric thrombosis, even in young women without comorbidities, and to pursue multidisciplinary, individualized management to balance timely surgery with preservation of bowel length.