Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis.
BACKGROUND
Acute venous mesenteric ischaemia is rare and there is no standard conservative or operative treatment.


METHODS
The results of surgical treatment for acute mesentericoportal thrombosis were retrospectively analysed in 31 patients. The thrombotic occlusion affected the superior mesenteric vein in 19 patients, the portal vein in eight and both vessels in four. Surgical treatment comprised venous thrombectomy (nine patients), bowel resection (17), a combination of thrombectomy and bowel resection (two), distal splenorenal shunt (one) and simple laparotomy (two).


RESULTS
When the mesentericoportal blood flow was restored, the mortality rate was lower, but not significantly so, than after bowel resection alone (two of nine versus seven of 17). In addition to thrombectomy, local thrombolysis with recombinant tissue plasminogen activator was performed in five patients via a catheter placed into a distal mesenteric vein and all survived. The overall hospital mortality rate was 11 (35 per cent) of 31.


CONCLUSIONS
An active approach should be encouraged in patients with this condition employing thrombectomy in addition to bowel resection. Early results are encouraging and local thrombolysis warrants further study.
Klempnauer
J
J
Department of Abdominal and Transplantation Surgery, Hanover Medical School, Germany.
Grothues
F
F
Bektas
H
H
Pichlmayr
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005734:Gangrene; D006801:Humans; D007238:Infarction / Q000188:drug therapy / Q000601:surgery; D007420:Intestine, Large / Q000098:blood supply; D007421:Intestine, Small / Q000098:blood supply; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D011169:Portal Vein; D019106:Postoperative Hemorrhage / Q000601:surgery; D011300:Preoperative Care; D012086:Reoperation; D013152:Splanchnic Circulation; D013164:Splenorenal Shunt, Surgical; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator