Abstract
A 66-year-old man seen at our hospital because of abdominal pain was suspected to have superior mesenteric vein thrombosis by an abdominal CT scan. Emergency operation was performed because he had peritoneal irritation sign. During surgery, we confirmed necrosis extending about 30 cm in length at the proximal jejunum, and performed partial jejunectomy. Intraoperative angiography through the superior mesenteric vein showed extensive thrombi from the superior mesenteric vein to the portal vein, so that the thrombi were removed as far as possible by using a Fogarty catheter, and the catheter was placed. Thrombolytic therapy was done after the operation. Angiography performed on the 24th postoperative day revealed improved hepatic blood flow through the superior mesenteric vein, though the remnants of thrombi were seen. The patient was discharged from the hospital on the 46th postoperative day. He presents portal hypertension at present, and he has been followed in the clinic while he is given warfarin. On an analysis of the serum, the protein C antigen was 21%, its activity level was 45%, the protein S antigen was 53% and its activity level was 58%, showing low levels in all parameters. Accordingly congenital protein C and S deficiency was considered.
This paper deals with a case of superior mesenteric vein thrombosois in which emergency operation and postoperative anticoagulant therapy saved the patient's life, with some bibliographic comments.
