Skip to main content

Endovascular management of bowel ischemia secondary to portal and mesenteric vein thrombosis

Abstract

Portal and mesenteric venous thrombosis (PMVT) is an uncommon disease, but it is a clinically important case of acute mesenteric ischemia. Its diagnosis is often delayed because of nonspecific abdominal symptoms. The treatment of PMVT involves anticoagulation therapy, alone or in combination with surgery. The addition of thrombolytic therapy to the treatment of PVMT may enhance the clearance of thrombus and hasten the clinical improvement. We herein present a case of bowel ischemia due to PVMT that was successfully treated with catheter-directed infusion of urokinase through the superior mesenteric artery and systemic anticoagulation in a patient with ascites and high blood international normalized ratio. We believe that this case demonstrates that slow and steady treatment with transarterial thrombolysis over 13 days can achieve the desired results compared with more aggressive transhepatic or transjugular thrombectomy or surgical thrombectomy, especially in high-risk patients with ascites and high international normalized ratio.

References

  1. Kumar S, Kamath PS. Acute superior mesenteric venous thrombosis: one disease or two?. Am J Gastroenterol 2003; 98:1299–1304.

    Article  Google Scholar 

  2. Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95:1245–1251.

    Article  CAS  Google Scholar 

  3. Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med 2010; 15:407–418.

    Article  Google Scholar 

  4. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345:1683–1688.

    Article  CAS  Google Scholar 

  5. Goldberg MF, Kim HS. Treatment of acute superior mesenteric vein thrombosis with percutaneous techniques. Am J Roentgenol 2003; 181:1305–1307.

    Article  Google Scholar 

  6. Spanier BW, Frederiks J. Aetiology of extrahepatic portal vein thrombosis. Gut 2002; 51:755–756.

    Article  CAS  Google Scholar 

  7. Webster GJ, Burroughs AK, Riordan SM. Review article: portal vein thrombosis — new insights into aetiology and management. Aliment Pharmacol Ther 2005; 21:1–9.

    Article  CAS  Google Scholar 

  8. Malkowski P, Pawlak J, Michalowicz B, Szczerban J, Wroblewski T, Leowska E, Krawczyk M. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003; 50:2098–2100.

    PubMed  Google Scholar 

  9. K Kandarpa, GA Gardiner Jr, FS Keller. Diagnostic angiography. In: K Kandarpa, ed. Handbook of interventional radiological procedures. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2011. 94.

    Google Scholar 

  10. Warshauer DM, Lee JK, Mauro MA, White GC. Superior mesenteric vein thrombosis with radiologically occult cause: a retrospective study of 43 cases. Am J Roentgenol 2001; 177:837–841.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shaileshkumar S. Garge MD, DNB.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garge, S.S., Vyas, P.D., Rasool, B.B. et al. Endovascular management of bowel ischemia secondary to portal and mesenteric vein thrombosis. Egypt J Intern Med 27, 75–77 (2015). https://doi.org/10.4103/1110-7782.159474

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.159474

Keywords