Idiopathic Portal Vein Thrombosis Treated by Continuous Antithrombotic Therapy from a Catheter Placed in the Portal Vein via the Ligamentum Teres Hepatis—A Case Report—

Abstract

Idiopathic portal vein thrombosis (IPVT) is a disease of unknown etiology that develops as a blood clot within the portal vein. Antithrombotic therapy is standard ; however, treatment may be difficult when a thrombus is widespread. Here, we successfully treated a young male patient with extensive portal vein thrombosis and intestinal necrosis. Four days after systemic anticoagulant therapy, the thrombus did not decrease in size, and ischemic changes were observed in the jejunum. Therefore, laparotomy was performed. A catheter was placed in the portal vein via the ligamentum teres hepatis, and thrombi in the superior mesenteric vein, portal vein trunk, and left and right portal vein branches were removed. Additionally, the necrotic jejunum was resected. The catheter was left in place in the SMV, and continuous anticoagulant therapy was administered after surgery. Postoperative respiratory, renal, and hepatic failure subsided, and the patient was discharged on day 37. Catheter placement via the ligamentum teres hepatis is useful for postoperative thrombosis therapy, even if the thrombosis is resistant to systemic anticoagulant therapy.