[The thrombolysis of a septic portal vein thrombosis with ultrahigh-dosage streptokinase].
Eight days after an appendicectomy a 40-year-old man developed a fever of up to 40.5 degrees C. The concentration of the transaminases was elevated (GOT 61 U/l, GPT 115 U/l, gamma-GT 226 U/l). Operative revision discovered no unusual wound conditions. Ultrasonography revealed splenomegaly (15 x 7 cm) and dilatation of the portal vein (diameter of 19 mm). The portal vein contained echo-dense constituents indicating thrombosis. Colour Doppler duplex sonography recorded only minimal residual flow around the thrombus. The fever gradually subsided under antibiotic treatment (metronidazole, 500 mg twice daily; mezlocillin, 2 g three times daily; later also gentamicin, 80 mg three times daily). Blood culture grew Bacteroides fragilis. 14 days after the wound revision ultra-high short-term lysis with streptokinase was instituted (9 mill IU over 6 hours), followed by heparin i.v. 25,000-30,000 i.v. daily for 5 days. 12 hours after the start of thrombolysis treatment the portal vein thrombus had been dissolved, and after 8 days the size of the spleen was normal.
Dahm
J B
JB
Medizinische Klinik, Paracelsus-Klinik, Hemer.
Riebeling
V M
VM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000601:surgery; D001442:Bacteroides Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D001441:Bacteroides fragilis; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D012086:Reoperation; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D013300:Streptokinase
Thrombolyse einer septischen Pfortaderthrombose mit ultrahochdosierter Streptokinase.