Vascular Specialist International  2014;30(4):155-158

doi:10.5758/vsi.2014.30.4.155

Combination of Surgical Thrombectomy and Direct Thrombolysis in Acute Abdomen with Portal and Superior Mesenteric Vein Thrombosis.

Hyuk Jae JUNG ; Sang Su LEE

Keywords

Portal vein thrombosis; Superior mesenteric vein thrombosis; Acute abdomen; Thrombectomy; Thrombolysis

Country

Republic of Korea

Language

English

Abstract

Portal vein (PV) thrombosis (PVT) is a rare condition with development of thrombosis in the PV and its branches. Further extension to the splenic and superior mesenteric vein (SMV) causes intestinal infarction, with a reported mortality of up to 50%. A variety of treatments for PVT exist including anticoagulation, thrombolysis, surgical thrombectomy, insertion of shunts, bypass surgery, and liver transplantation. We experienced a case of successfully treated by surgical thrombectomy with direct thrombolysis into the thrombosed-PV and SMV. A 31-year-old male presented worsening abdominal pain for one week. Preoperative contrast enhanced computed tomography scan revealed complete PVT extending to splenic vein and SMV. The PV was accessed surgically and opened by thrombectomy; visual inspection confirmed proximal and distal flow. Urokinase was administered directly into the inferior mesenteric vein with successful decrease in thrombus burden. The complete angiography showed complete dissolution of thrombosis in PV and SMV.