Intestinal ischemia and infarction associated with oral contraceptives
Schneiderman, D.J.; Cello, J.P.
Western Journal of Medicine 145(3): 350-355
1986
ISSN/ISBN: 0093-0415 PMID: 3765615 Document Number: 352203
The authors analyze 41 cases of temporary intestinal ischemia (15) or frank infarction (26) reported in the literature among oral contraceptive users. Like women with other thromboembolic diseases, duration of pill use was not a factor: these women had been taking orals for 10 days to 10 years, mean 2.2 years. Reversible ischemia resolved in days or weeks after discontinuing oral contraceptives, with supportive treatment. The best diagnostic tool was barium contrast radiogaphy. Neither arteriography or colonoscopy were helpful. Lesions were continuous, narrow, spastic, often with "thumbprinting", sometimes with proximal dilation. Intestinal infarction, usually determined at laparotomy, was fatal in 31%. Resection was necessary for gangrenous, pale or edematous small or large intestine or both. Most often the superior mesenteric artery or vein were involved. 42% needed a second laparotomty. Only 2 women developed ischemia or necrosis after oral contraceptives had been discontinued: both had documented arterial occlusion in all 3 major vascular trunks. The physiological cause of oral contraceptive-related ischemia or infarction is controversial. Several mechanisms including blood clotting factors, lipoproteins, platelet activity are reviewed. The evidence for the pill being involved in these cases is the young age and lack of preexisting risk factors, and especially resolution of the condition on stopping the pill, in the affected women.