Visceral Arterial Thrombosis Linked to Long-Term Oral Contraceptives and Smoking: A Case Report.

BACKGROUND This report describes the case of a 51-year-old woman with a history of smoking and oral contraceptive use presenting with thrombosis of the hepatic, superior mesenteric, splenic, and left renal arteries. Oral contraceptive use is associated with an increased risk of both venous and arterial thrombosis, including visceral arterial thrombosis. This report presents a rare case of extensive visceral arterial thrombosis potentially related to the combined risk factors of long-term oral contraceptive use and long-term smoking. CASE REPORT A 51-year-old woman presented with severe abdominal pain localized to the epigastrium and left flank pain, nausea, vomiting, and fever persisting for over 24 hours. Contrast-enhanced computed tomography (CT) revealed extensive thrombosis involving the hepatic, superior mesenteric, splenic, and left renal arteries. She had a 20-year history of continuous oral contraceptive use and long-term smoking but did not have a family history or laboratory evidence of a hypercoagulable disorder. She was treated successfully with anticoagulation and supportive care despite complications from heparin-induced thrombocytopenia (HIT). CONCLUSIONS This case illustrates the increased risk of extensive visceral arterial thrombosis in women using second-generation oral contraceptives and who are long-term smokers. It emphasizes the diagnostic and therapeutic challenges in managing multifocal visceral arterial thrombosis, particularly when driven by non-genetic, modifiable risk factors. Early recognition and timely initiation of appropriate anticoagulation therapy can lead to favorable outcomes, although clinicians must remain alert to complications such as HIT during treatment.