[Septic portal vein thrombosis. Its successful therapy by local fibrinolysis and a transjugular portasystemic stent-shunt (TIPS)].
METHODS
A 68-year-old man, without any preceding hepatic or abdominal disease, suddenly developed a severe septic illness with consumptive coagulopathy and upper abdominal pain. B-mode and duplex ultrasonography revealed fresh portal vein thrombosis. Despite extensive conservative measures there was no significant improvement after one week and further thrombus extension with threatened acute mesenteric vein occlusion.


METHODS
Local fibrinolysis with recombinant plasminogen activator and urokinase via percutaneous transjugular intrahepatic catheterization of the portal vein achieved almost complete dissolution of the thrombus within 3 days. Subsequently the portal vein catheter was changed into a transjugular portosystemic stent shunt (TIPS).


CONCLUSIONS
While local or systemic fibrinolysis has been practised in previously reported cases of acute portal vein thrombosis, the described use of TIPS introduces a new element. The shunt between hepatic and portal veins assures therapeutic access to the portal venous bed. It lowers portal vein pressure and can diminish the danger of recurrent thrombosis by raising portal flow. This minimally invasive procedure may be a nearly ideal treatment even in the course of portal vein thrombosis which has a high complication rate.
Mann
O
O
Medizinische Klinik I, Städtische Kliniken Kassel.
Haag
K
K
Hauenstein
K H
KH
Rössle
M
M
Pausch
J
J
D000368:Aged; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000628:therapy; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000628:therapy; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D011169:Portal Vein / Q000000981:diagnostic imaging; D011170:Portasystemic Shunt, Surgical / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000628:therapy*; D014463:Ultrasonography
Septische Pfortaderthrombose. Erfolgreiche Therapie durch lokale Fibrinolyse und transjugulären portosystemischen Stent-Shunt (TIPS).