Abstract
A 68-year-old man visited our hospital with a 2-day history of abdominal pain. He had mild tenderness all over the abdomen, but no signs of peritoneal irritation. Abdominal contrast-enhanced CT revealed thrombi in the main trunk of the portal vein, splenic vein and superior mesenteric vein (SMV). There was extensive wall thickening, mainly caused by submucosal edema of the small intestine, and ascites, however, the gut wall was clearly delineated. Based on the above findings, the patient was diagnosed as having SMV thrombosis and unlikely to have intestinal necrosis, and thrombolysis via a catheter placed in the superior mesenteric artery (SMA) was planned. Urokinase was administered by continuous infusion at the dose of 240000 units/day for 5 days. Abdominal contrast-enhanced CT showed decreased thrombi in the main trunk of the portal vein and SMV and contrast enhancement in the inner periphery on day 6. In addition, the thickening of the small intestinal wall was also reduced. The subsequent clinical course was satisfactory and the patient was discharged on day 15. On the abdominal contrast-enhanced CT performed 6 months after the thrombolysis, the main trunk of the portal vein, SMV and splenic vein could no longer be seen. Well-developed cavernous transformation was seen at the hilus hepatis. Thrombolysis via a catheter placed in the SMA could be an effective treatment option for SMV thrombosis without intestinal necrosis.
