A Rescued Case of Superior Mesenteric and Portal Vein Thrombosis

Tatsuharu Yamada, Yoichiro Kobayashi, Kanji Miyata, Fumihiko Yoneyama, Yasutomo Goto, Eiji Takeuchi, Koji Komori, Yuichi Takayama, Shinya Watanabe and Masanori Uno

Department of Surgery, Japanese Red Cross Nagoya First Hospital

We report a case of superior mesenteric vein (SMV) and portal vein (PV) thrombosis. A 47-year-old man referred for upper abdominal pain suspected of being strangulation ileus underwent emergency laparotomy. Intraoperating findings showed congestive necrosis of the jejunum approximately 100 cm long located 10 cm from the Treitz ligament and due to thrombosis of the SMV and PV. Following bowel resection with primary anastomosis, SMV and PV thrombectomy was done using a Fogarty catheter. Urokinase and heparin were administered immediately postoperatively into the PV. Despite perioperative shock status, the man's condition gradually improved postoperatively. The right portal vein was recanalized from collateral vessels around the hepatoduodenal ligament. In this case, adding to bowel resection, thrombectomy and postoperative direct thrombolysis and anticoagulant therapy to the PV is thought to have been effective.

Key words
mesenteric and portal vein thrombosis, thrombectomy, direct thrombolysis

Reprint requests
Tatsuharu Yamada Department of Surgery, Japanese Red Cross Nagoya First Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
October 19, 2004

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