Aortic mural thrombi in patients with inflammatory bowel disease: report of two cases and review of the literature

Inflamm Bowel Dis. 2004 Jul;10(4):430-5. doi: 10.1097/00054725-200407000-00016.


Thromboembolic events are a known complication in inflammatory bowel disease (IBD). We report on 2 young women with IBD and aortic mural thrombi as a source of arterioarterial embolization to the lower limbs resulting in significant morbidity. The first case was a 36-year-old woman with severe ulcerative colitis who presented with signs of microembolism into two toes of her right foot. A thrombus in the otherwise normal infrarenal aorta with occlusion of the inferior mesenteric artery was revealed by computed tomography (CT) and intrarterial angiography. The digital ischemia resolved without sequelae. The second case was a 41-year-old woman with Crohn's disease complicated by fistulas. She developed acute ischemia of her right leg. Arteriography and CT revealed infrapopliteal embolic occlusions and a thrombus in the distal otherwise normal abdominal aorta and the left iliac artery. A primarily successful thrombectomy had to be repeated 5 times because of reocclusion. Eventually the leg was exarticulated at the knee. In both patients no further thromboembolic event occurred during follow-up of 4 1/2 years and 5 1/2 years, respectively, and aortic thrombi had resolved at follow-up CT scans. Extensive work up for hypercoagulability was negative in both patients. We consider IBD as the most likely trigger for arterioarterial embolization in the absence of thrombophilia in both patients. Finally we give an overview of the literature of similar cases with aortic mural thrombi in IBD patients.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aorta / pathology
  • Colitis, Ulcerative / complications*
  • Crohn Disease / complications*
  • Female
  • Heart Diseases / etiology*
  • Heart Diseases / surgery
  • Humans
  • Recurrence
  • Thrombophilia
  • Thrombosis / etiology*
  • Thrombosis / surgery
  • Tomography, X-Ray Computed