Recurring Abdominal Pain: The Hidden Clue of Antiphospholipid Syndrome

Abstract

Recurrent abdominal pain is a common clinical presentation, yet when episodes are severe, episodic, and unexplained by routine gastrointestinal investigations, vascular etiologies must be considered. We present a 52-year-old previously healthy man with a six-week history of intermittent, severe central abdominal pain, culminating in an acute exacerbation. Prior evaluations, including ultrasound, non-contrast CT, and endoscopy, were unrevealing. On acute presentation, laboratory studies demonstrated elevated D-dimer and mild lactate elevation, prompting contrast-enhanced CT angiography, which revealed a proximal superior mesenteric artery thrombus with preserved bowel viability. Further workup confirmed triple-positive antiphospholipid syndrome (APS), establishing the underlying prothrombotic etiology. The patient underwent urgent systemic anticoagulation with unfractionated heparin followed by successful endovascular thrombectomy and catheter-directed thrombolysis. He was subsequently transitioned to long-term warfarin therapy with multidisciplinary follow-up. This case highlights the protean manifestations of APS, demonstrating that recurrent, transient mesenteric ischemia may precede catastrophic arterial thrombosis. Early recognition, prompt vascular imaging, and tailored anticoagulation—combined with minimally invasive revascularization when feasible—are pivotal in preventing bowel infarction and optimizing outcomes. Clinicians should maintain high suspicion for APS in atypical thrombotic presentations beyond the classic venous or cerebrovascular events.