A Case of Primary Superior Mesenteric and Portal Venous Thrombosis Performed a Second-look Operation

Shigeto Makino¹⁾²⁾, Yasuyuki Kawachi¹⁾, Takao Shimizu²⁾, Atsushi Nishimura¹⁾, Keiya Nikkuni¹⁾, Takeaki Shimizu¹⁾ and Katsuyoshi Hatakeyama²⁾

Department of Surgery, Nagaoka Chuo General Hospital¹⁾
Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University²⁾

A 49-year-old man referred for severe abdominal pain after about 10 days from the onsets of slight abdominal pain to have superior mesenteric and portal venous thrombosis was found in abdominal computed tomography (CT) necessitating emergency laparotomy. Despite partial resection of the jejunum of about 200 cm long including the necrotic part and thrombectomy for the superior mesenteric and portal vein was performed, a thrombus remained in the superior mesenteric vein (SMV) and portal vein (PV) and extended to the peripheral veins of the surrounding mesenteruim. We completed surgery without closing the abdominal wound and started anticoagulation therapy with continuous heparin administration. About 12 hours after primary surgery, a second-look operation showed no appearance of new necrotic lesions. Six weeks after surgery CT showed the thrombus in SMV and PV had disappeared. The patient in now being followed up by administration of oral anticoagulation therapy for warfarin and has had no recurrence of SMV or PV thrombosis. In such cases, a second-look operation may help to minimize the amount of the segment resected in the small intestine.

Key words
primary superior mesenteric venous thrombosis, primary portal venous thrombosis, second-look operation

Reprint requests
Shigeto Makino Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University
1-757 Asahimachidori, Niigata, 951-8510 JAPAN

Accepted
October 19, 2005

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