A Case of Superior Mesenteric Vein Thrombosis Treated with Conservative Therapy

Kazuhiro Toyota, Hirofumi Nakatsuka, Yasuhiro Matsugu, Takayuki Ogawa and Hisashi Oshiro

Department of Surgery, Kure City Medical Association Hospital

Early diagnosis of superior mesenteric vein (SMV) thrombosis is difficult due to the lack of specific symptoms. Case studies have indicated surgical intervention to be the primary life-saving approach. We treated a 64-year-old man with appendicitis with SMV thrombosis using conservative therapy and followed up treatment with computed tomography (CT). The patient underwent conservative therapy upon diagnosis of acute appendicitis at a nearby hospital and experienced abdominal inflation with fever before being referred to us. On admission, he had leukocytosis and abnormal hepatic functions. Abdominal CT showed SMV thrombosis induced by appendicitis. Conservative therapy with antibiotics and continuous heparin administration was initiated, and abdominal findings thereafter indicated slight improvement, with the thrombus contracted within 1 week of treatment as seen in CT. Chemotherapy was then replaced by warfarin, and the patient was discharged when the third CT scan showed the thrombus had disappeared. Appendicitis recurring after discharge necessitated laparoscopic appendectomy. In the year since surgery, the man has experienced neither recurrence of thrombosis nor ileac signs.

Key words
SMV thrombosis, acute appendicitis

Reprint requests
Kazuhiro Toyota Department of Surgery, Kure City Medical Association Hospital 15-24 Asahimachi, Kure, 737-0056 JAPAN

Accepted
May 23, 2001

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