A Case of Primary Thrombosis of the Superior Mesenteric Vein and Portal Vein

Wataru Matsuhashi, Yoshikura Haraguchi, Syunji Hasegawa, Hiroyuki Ohsawa, Manabu Kirita, Souichi Umezu, Tsutae Nagata, Keiichi Saitoh

Department of Surgery, Tokyo Metropolitan Police Hospital

Superior mesenteric vein thrombosis is a serious and rare condition of acute abdomen that is characterized by nonspecific sumptoms and slow progress, which makes preoperative diagnosis difficult. We recently encountered a case of superior mesenteric vein thrombosis, which was diagnosed preoperatively by means of a CT scan with contrast enhancement. Our patient is a 47-year-old male Japanese who had abdominal pain as the chief complaint. He was hospitalized 12 days after the onset of the abdominalgia. On physical examination, a dilated bowel was felt in the left upper abdomen. A plain CT scan revealed ascites as well as a swollen mesenterium and small intestine. A CT scan with contrast enhancement revealed the superior mesenteric vein with a central defect considered to be due to a thrombus. Surgery was performed on the following day, or 13 days after onset. Bloody ascitsic fluid and congestive necrosis of the jejunum were found and jejunectomy 170 cm in length was performed. The thrombosis progressed during the operation and additional resection was necessitated. For the purpose of postoperative observation of the blood flow in the cutend of the intestine, bilateral ileostomy was performed. Postoperative angiography revealed extensive thrombus formation in the superior mesenteric vein and the portal vein. The coagulation and fibrinolysis parameters of this patient were normal and we considered this a case of primary thrombosis. Thrombolytic and antiplatelet agents were administered postoperatively. The ileostomies were closed on the 39th postoperative day and the patient was discharged on the 60th day.

Key words
superior mesenteric vein thrombosis, portal vein thrombosis, bowel necrosis

Reprint requests
Wataru Matsuhashi Department of Surgery, Tokyo Metropolitan Police Hospital
2-10-41 Fujimi, Chiyoda-ku, Tokyo, 102 JAPAN

Accepted
September 9, 1992

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