A CASE OF SUPERIOR MESENTERIC VENOUS THROMBOSIS CAUSED BY PORTAL HYPERTENSION

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 65; no. 10; pp. 2775 - 2779
• Main Authors: SUZUKI, Yasushi, DATE, Yuko, KUSANO, Mitsuo, TSUSHIMA, Hidefumi, MORI, Hideki
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2004
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.65.2775

We have experienced a patient with superior mesenteric venous thrombosis, who had been followed for liver cirrhosis. A 56-year-old man was admitted to the hospital because of acute lower abdominal pain lasting for this morning. An abdominal contrast enhanced CT scan showed superior mesenteric venous thrombosis and massive edema of the mesenterium. Under a diagnosis of superior mesenteric venous thrombosis, an emergency operation was performed 6 hours after the onset of the symptom. At this operation, we admitted hemorrhagic ascites and necrosis of the small intestine, extending about 120cm in length from a point 15cm proximal to the ileocecal region. We removed the thrombus in the mesenteric vein, resected the necrotic segment of the small bowel (total 150cm) including a probably normal part, and performed end-to-end anastmosis. Anticoagulation therapy with heparin was done for 5 days after the operation. On the 7th postoperative day, an abdominal contrast enhanced CT scan showed contraction of the thrombus in the mesenteric vein and expansion of the lumen. No development of thrombus was recognized. The patient recovered and was discharged from the hospital on the 29th postoperative day. There have been no signs of recurrence as of 27 months after the operation. It is important to resect a necrotic segment of the small bowel including a part which seems normal, because thrombus can remain in the veins of the seemingly normal bowel.