A Case Report of Primary Superior Mesenteric, Portal and Splenic Vein Thrombosis

Kazuhiro Iwai, Toru Takahashi, Yasuhumi Mito and Kousaku Satou

Department of Surgery, Tomakomai Oji General Hospital

We experienced a case of superior mesenteric, portal and splenic vein thrombosis with massive intestinal necrosis. The patient was a 38-year-old man. Emergency laparotomy was performed with a diagnosis of acute abdomen due to intestinal infarction 2 days after the onset of upper abdominal pain. Massive resection of necrotic intentine, which included a section that began 20cm on tha anal side of the Treitz ligament to 40cm on the oral side of the ileocecal juncture, was performed and jejunostomy and ileostomy were performed without anastmosis. Necrosis of the cut end of intestine was not observed, but marked edema of the intestine continued and noted. Eight days after operation we noticed a portal vein thrombus on the preoperative CT scan and suspected superior mesenteric and portal vein thrombosis. Subsequently patency of the superior mesenteric artery and obstruction of the superior mesenteric portal and splenic vein with thrombus were revealed by angiography. On the same day, we performed thrombectomy and anastomosis of intestine. The postoperative course was uneventful. Complete recanalization of the superior mesenteric, portal and splenic veins was demonstrated by angiography on 75 days after the first operation. In spite of the shortened bowel (50cm in length), he is being followed-up without special nutritional support 2 years of after the first operation.

Key words
mesenteric vein thmombosis, thrombectomy of portal venous system, massive resection of ileum

Reprint requests
Kazuhiro Iwai Department of Surgery, Oji general Hospital 3-4-8 Wakakusacho, Tomakomai City, 053-8506 JAPAN

Accepted
May 25, 1999

To read the PDF file you will need Abobe Reader installed on your computer.