TITLE:
Acute Congenital Non-Traumatic Ischaemia of the Lower Limb and Subrenal Ischaemia Secondary to Congenital Thrombophilia in a Newborn: A Case Report and Review of the Literature
AUTHORS:
Ndiaga Diakhaté, Lamine Thiam, Tahirou B. Diallo, Cheikh Tidjane Mbaye, Christ Tsague Momo, Ndeye Rama Diagne, Papa Moctar Faye
KEYWORDS:
Newborn, Ischaemia, Thrombophilia, Ziguinchor
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.1,
January
5,
2026
ABSTRACT: Acute ischaemia (AI) is an extreme medical and surgical emergency. It is rare in newborns but also extremely serious due to its functional and life-threatening complications. Diagnosis can sometimes be difficult, which is why this case is being presented. This is a newborn hospitalised in the paediatric ward of La Paix Hospital in Ziguinchor for lower limb and subrenal ischaemia extending to the common iliac arteries. On admission, the examination revealed coldness in the left foot with a painful, flat, monomorphic purpuric area on the anterior-external aspect of the left leg, the lower third of the leg, the back of the foot, and the 2nd, 3rd, and 4th toes. There was also no pedal pulse, normal temperature and cyanosis of the left foot. The rest of the clinical examination was unremarkable. The Doppler ultrasound performed on admission was normal. The CT angiogram performed after five days of hospitalisation showed total thrombosis of the subrenal aorta extending to the common iliac arteries and complete thrombosis of the distal two-thirds of the leg arteries extending to the foot. Laboratory tests showed hyperleukocytosis at 15,490 (neutrophils: 67.4%), negative CRP, thrombocytopenia at 147,000, and normal renal function. Blood count was normal. Cardiac ultrasound was normal. Protein C levels returned to 27.52% functional activity and protein S to 35% functional activity. We believe this is likely to be a congenital thrombophilia. However, a follow-up assessment is required to confirm the congenital origin of the deficiency. Treatment consisted of two injections of 100 units/kg of low molecular weight heparin combined with 0.1 mg/kg of acenocoumarol. The condition progressed to dry necrosis of the affected area, with dry, hard skin and a cardboard-like appearance forming a well-defined black patch. Secondarily, he presented with loss of substance, exposing the bones and tendons. An amputation was performed on day 20 of hospitalisation. The postoperative course was uneventful. Acute ischaemia in newborns is still a rare condition and constitutes a medical and surgical emergency. Symptoms remain important in diagnosis, but imaging is crucial. Conservative treatment is recommended, but in certain situations, minimally invasive treatment or amputation must be performed.