A Case of Portal Vein Thrombosis after Hassab's Operation Successfully Treated with Thrombolytic Therapy

Hiroshi Ohtani, Kenji Mizukami, Sadatoshi Shimizu, Katsumi Ikeda, Masahiro Nishikawa, Shinichi Taguchi, Yousuke Fukunaga, Shinya Tanimura, Yasuhisa Fujimoto and Masayuki Higashino

Department of Gastroenterological Surgery, Osaka City General Hospital

In a case of portal vein thrombosis after Hassab's operation treated with transvenous thrombolytic therapy, a 51-year-old man, followed up for liver cirrhosis derived from C-type hepatitis and esophagogastric varices underwent Hassab's operation due to severe hypersplenism (WBC: 800/μl, Plt: 30,000/μl). After surgery, portal vein thrombosis occurred in spite of preventive medication of aspirin (81 mg/day). The patient was immediately given urokinase, low molecular heparin, and gabexate mesilate intravenously. Several days later signs of thrombolysis were recognized and 10 days thereafter, almost complete thrombolysis was confirmed in the intrahepatic portal vein and portal trunk. Portal vein thrombosis is a serious complication of Hassab's operation. Early determination of portal vein thrombosis is made by imaging diagnosis. When portal vein thrombosis is confirmed in spite of oral anticoagulant therapy, thrombolytic treatment should be begun immediately. Thrombolytic treatment should be replaced by anticoagulant therapy as soon as adequate thrombolysis is determined.

Key words
portal vein thrombosis, Hassab's operation, transvenous thrombolytic therapy

Reprint requests
Hiroshi Ohtani Department of Gastroenterological Surgery, Osaka City General Hospital 2-13-22 Miyakojima-hondouri, Miyakojima-ku, Osaka, 534-0021 JAPAN

Accepted
November 29, 2000

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