Abstract
A 74-year-old man visited a general hospital because of abdominal distension. He was found to have a large tumor that occupied the entire abdominal cavity and appeared to come from the gastric wall. He was referred to our hospital where we made a preoperative diagnosis of a gastrointestinal stromal tumor (GIST) of the stomach with portal outflow and hypervascularity. The tumor was removed and a partial gastrectomy was performed. On the tenth postoperative day, the patient complained of mild fatigue and thrombus formation primarily from the main trunk to the right branch of the portal vein was identified. Anticoagulation therapy with an i. v. injection of 15,000 units/day of heparin and oral administration of warfarin (2 mg) was immediately started. An abdominal CT scan performed on the 18th postoperative day showed remarkable shrinkage of the thrombus in the portal vein and it completely disappeared on the 30th postoperative day. The warfarin oral regimen alone was continued ; there has been no recurrence. The patient was discharged from the hospital on the 33rd postoperative day. In patients requiring surgical removal of hypervascular tumors with a portal flow, one must keep in mind that postoperative portal vein thrombosis can occur.
