Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy.
A 69-year-old man, with hepatits C virus-related liver cirrhosis and hemophilia B, developed massive ascites and watery diarrhea after endoscopic injection sclerotherapy for esophageal varices. A multi detector row computed tomography revealed a superior mesenteric venous thrombus without bowel infarction. It was assumed that the thrombus was caused by transient congestion of the portal system after retrograde propagation of the sclerosant agent, in a condition where anticoagulation proteins, such as proteins C and S, had decreased. Because long systemic thrombolytic therapy was hazardous for the patient with hemorrhagic diathesis due to impaired coagulation, a direct thrombolysis was performed with urokinase followed by aspiration thrombectomy, with cannulation of the portal venous system using a transjugular intrahepatic approach. The patient had no complications in this procedure and subsequently diarrhea and refractory ascites were resolved. Direct thrombectomy via the transjugular intrahepatic route may be a useful therapy for mesenteric venous thrombus in the cirrhotic patient.
Nakayama
Satoshi
S
Department of Gastroenterology, Mishuku Hospital, Meguro, Tokyo, Japan. s-nakayama@mishuku.gr.jp
Murashima
Naoya
N
Isobe
Yoshinori
Y
D000368:Aged; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000628:therapy*; D008642:Mesenteric Veins; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D020246:Venous Thrombosis / Q000628:therapy*