A Case Report of Primary Diffuse Thrombosis of the Portal System

Yuichi Tanaka, Takao Hanaoka, Tamotsu Kudo, Rikko Lee, Shinichiro Ouchi, Akira Tsuchiya, Yoshiaki Shindo, Taiji Seto, Toshifumi Suzuki*

Departments of Surgery and Radiology*, Nakadori General Hospital

We are reporting a case of diffuse thrombosis of the portal system, diagnosed preoperatively by means of CT scan. The patient was a 68-year-old man with no particular problems in his medical history. His chief complaints were abdominal fullness, epigastralgia and diarrhea. He was hospitalized 4 days after the onset. Physical examination revealed progressive abdominal distension with muscular defense. A plain CT scan disclosed occlusion of the splenoportal and superior mesenteric veins due to diffuse thrombus. Thrombus in the peripheral mesenteric veins and the thickened small intestine were also obserbed. Abdominal angiography demonstrated no visualization of the portal system. Surgery was performed on the same day. Bloody ascites and congestive necrosis of the small intestine were found, and venous thrombectomy and massive intestinal resection, 260 cm in length, were performed. Anticoagulant therapy was started during the operation. Postoperative angiography and CT scan clarified occlusion of the portal vein and the right portal branch, patency of the splenic vein and collateral circulation around the portal vein. The coagulation and fibrinolysis parameters of this patient were normal, and we considered this a case of primary thrombosis. In spite of the shortened bowel (40 cm in length), he is being followed without any special nutritional support.

Key words
diffuse thrombosis of the portal system, thrombectomy, massive intestinal resection

Reprint requests
Yuichi Tanaka Department of Surgery, Nakadori General Hospital
3-15 Misono-cho, Minami-dori, Akita, 010 JAPAN

Accepted
July 6, 1994

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