Marshad M, Maresch M, Al Abbasi T
Bahrain Defence Force Hospital, West Riffa, Bahrain.
BDF Hospital, Bahrain.
Int J Surg Case Rep. 2018;53:242-245. doi: 10.1016/j.ijscr.2018.09.030. Epub 2018 Oct 5.
Acute portal and superior mesenteric vein thrombosis(SMV) is a rare but potentially lethal condition that is often characterized by generalized and non-specific symptoms. A high index of suspicion is warranted for early diagnosis and management. We present a case of 54 year old male who presented with generalized abdominal pain which was later accompanied by hemodynamic instability and radiological diagnosis of portal vein and superior mesenteric vein thrombosis.
The management of SMV can be divided into medical and surgical therapy. Patients who have clear signs of peritonitis will require emergent surgery. Interventions for life-threatening portal vein thrombosis are limited and poorly described in the literature.
We report a case of extensive portal vein thrombosis(PVT) advancing proximally to involve the superior mesenteric vein. Rapid portal vein patency and improved hepatic function was achieved with the direct use of tissue plasminogen activator infusion via operatively placed middle colic vein catheter.
急性门静脉和肠系膜上静脉血栓形成（SMV）是一种罕见但可能致命的疾病，通常表现为全身性和非特异性症状。早期诊断和治疗需要高度的怀疑指数。我们报告一例54岁男性患者，该患者最初表现为全身性腹痛，随后出现血流动力学不稳定，并经影像学诊断为门静脉和肠系膜上静脉血栓形成。
SMV的治疗可分为药物治疗和手术治疗。有明确腹膜炎体征的患者需要紧急手术。对于危及生命的门静脉血栓形成的干预措施有限，且文献中对此描述较少。
我们报告一例广泛的门静脉血栓形成（PVT），血栓向近端发展累及肠系膜上静脉。通过经手术置入的结肠中静脉导管直接输注组织纤溶酶原激活剂，实现了门静脉快速再通并改善了肝功能。
