An Effective Case of Thrombolytic Therapy to Primary Superior Mesenteric Thrombus

Naoto Nishigori, Satoru Akashi, Yasunobu Sasaki, Takeshi Matsuyama, Masami Imanishi, Shinya Takeyama¹⁾, Toshiya Nakatani¹⁾, Masahiko Sakamoto²⁾, Tetsuya Yoshioka²⁾ and Shoichiro Kawaguchi

Emergency and Critical Care Medical Center, Department of Digestive Tract Internal Medicine¹⁾ and Department of Radiology²⁾, Nara Prefectural Nara Hospital

A 48-year-old woman with upper abdominal pain was found in abdominal enhanced Computed Tomography to have a thrombus in the SMV. The absence of peritoneal irritation suggested that intestinal necrosis was unlikely symptom. because of no symptom. Venous phase angiography 7 hours after onset showed that the last branch of the ileal vein was in poor phase. We undertook thrombolytic therapy by urokinase infusion via a catheter in the SMA and systemic heparinization. After that, the last branch of ileal vein became to be displayed behind time. The woman was administered started to take warfarin orally 4 days after pain onset and was discharged after conservative treatment. Had intestinal necrosis occurred, the possibility was high that we would have had to massively resect the small intestine, which can be severely detrimental to the quality of life in patients.

Key words
primary superior venous thrombosis, thrombolytic therapy, urokinase

Reprint requests
Naoto Nishigori Emergency and Critical Care Medical Center, Nara Prefectural Nara Hospital
1-30-1 Hiramatsu, Nara, 631-0846 JAPAN

Accepted
June 27, 2007

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