Superior Mesenteric and Portal Vein Thrombosis Caused by Congenital Antithrombin III Deficiency: Report of a Case

A 50-year-old man presented with a 24-h history of gradually worsening abdominal pain. Enhanced computed tomography showed segmental dilation of the small intestine, wall thickening, and ascites, as well as thrombosis of the superior mesenteric vein (SMV) and portal vein. Thus, an emergency laparotomy was performed, which revealed segmental intestinal infarction caused by the thrombosis in the SMV and portal vein. We resected the necrosed intestine and performed anastomosis. The patient was given intravenous heparin and nafamostat mesilate as anticoagulation therapy. The abdominal pain again recurred 4 days after this operation, necessitating a second laparotomy. Segmental congestion of the intestine was found and another resection was done, after which he recovered rapidly. Blood chemistry subsequently revealed an antithrombin III deficiency, which was confirmed to be inherent, after screening his family. Thus, laboratory testing for these proteins may help define the cause of mesenteric venous thrombosis.     

肠系膜上静脉血栓形成的诊治

目的：探讨肠系膜上静脉血栓形成的临床诊治经验。方法：回顾性分析20例肠系膜上静脉血栓形成的临床资料。手术者10例,8例行坏死肠管切除吻合,2例行坏死肠管切除0281期造瘘。其余10例行抗凝溶栓祛聚治疗。结果：18例治愈,2例术后死于并发症。结论：肠系膜上静脉血栓形成无腹膜炎体征者可行非手术治疗,有腹膜炎体征或肠已坏死者,应即时手术治疗。     

Pulmonary and Deep Vein Thrombosis in a Young Patient with Protein S Deficiency: Report of a Case

A 27-year-old man, who was diagnosed as having familial protein S deficiency, developed deep vein thrombosis complicated with pulmonary thromboembolism. Anticoagulant therapy and thrombolytic therapy were commenced after the insertion of a temporary inferior vena cava filter (t-IVC-f). However, on day 5 after t-IVC-f insertion, IVC venography showed filter thrombosis. On day 13, we made a venotomy and removed the captured thrombi and inserted a permanent IVC-f. After removal of the t-IVC-f via the right brachial vein, thrombi that had not been seen earlier appeared in the right atrium (RA). It was suspected that the thrombi around the catheter had likely been stripped off during the catheter removal procedure. After the abdomen was closed, an extra operation was immediately performed. Under complete extracorporeal circulation, the RA was opened and the all thrombi were removed. The patient recovered well and was discharged on the 21st postoperative day without any complications.     

Portal Vein Thrombosis Caused by Microwave Coagulation Therapy for Hepatocellular Carcinoma: Report of a Case

Microwave coagulation therapy (MCT) is one of the treatment modalities for patients with hepatocellular carcinoma (HCC). A 67-year-old man with liver cirrhosis underwent MCT during a laparotomy for a deeply located HCC (2.5 cm in diameter) at the border of the anterior and posterior segments of the right hepatic lobe. Two weeks after MCT, he complained of abdominal fullness. Portal vein thrombosis (PVT) was diagnosed because he had massive ascites and an echogenic mass in the portal vein on abdominal ultrasonography. PVT was successfully treated by fibrinolytic therapy with a selective infusion of urokinase via the superior mesenteric artery (SMA). There have been few reports on PVT as a complication of MCT. Attention should be paid to the possible occurrence of PVT as a critical complication after MCT for liver tumors adjacent to the portal vein. Fibrinolytic therapy via the SMA is thus considered to be an effective approach for PVT after MCT. Received: July 19, 1999 / Accepted: March 24, 2000     

经皮肝穿刺门静脉置管溶栓治疗急性肠系膜上静脉血栓(附7例报道)

目的探讨经皮肝穿门静脉置管溶栓治疗急性肠系膜上静脉血栓的效果。方法回顾性分析我院2005年8月至2009年4月期间通过经皮肝穿门静脉置管溶栓对7例急性肠系膜上静脉血栓患者的治疗情况及疗效。结果 7例经皮肝穿门静脉置管均成功,穿刺后无漏胆,无腹腔出血。患者腹痛、腹胀和血便症状在2～5d内缓解,2～5d开始进食流质。1例患者因症状加重而行急诊手术,无肠瘘发生。复查造影显示大部分或全部血栓被清除,门静脉和肠系膜上静脉血流通畅。随访3个月至3年,均无复发。结论经皮肝穿门静脉置管溶栓治疗急性肠系膜上静脉血栓是安全、有效的。     

下肢深静脉血栓手术与溶栓治疗效果的比较

目的评价手术与溶栓治疗下肢深静脉血栓的疗效。方法回顾性收集新疆医科大学两所附属医院住院的下肢深静脉血栓患者86例,根据治疗方式分为溶栓组与手术组,溶栓组74例,手术组12例。手术组运用Fogarty导管取栓加溶栓;溶栓组运用药物治疗(尿激酶或降纤酶)。结果出院时手术组治愈8例,好转4例,没有无效病例;溶栓组治愈15例,好转50例,无效9例。随访3～100个月,平均27个月。手术组瓣膜功能正常者6例,溶栓组有9例。手术组的急性期缓解率、远期通畅率、瓣膜功能正常率均明显高于溶栓组(P<0.05),且手术组血栓后综合征发生率明显低于溶栓组(P<0.05)。结论早期手术能够保持深静脉通畅及瓣膜的完整性,能够减少深静脉血栓后综合征,早期溶栓仅能减轻症状,但不能减少瓣膜的损害。     

门静脉血栓形成的诊断与治疗

目的：探讨门静脉血栓形成的诊断与治疗方法。方法：15例门静脉血栓形成患者行抗凝、溶栓、祛聚治疗。结果：6例门静脉部分或完全再通,2例出现小肠坏死转为手术治疗,1例死亡,6例好转。手术患者无并发症和死亡。15例2周后血清D-dimmer水平明显下降（P〈0.05）。结论：门静脉血栓形成应早期诊断,根据具体的病情选择合理的治疗方法。     

Isolated Superior Mesenteric Vein Injury from Blunt Abdominal Trauma: Report of a Case

Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury. A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5 m. Computed tomography (CT) showed blood in the peritoneal cavity, but no liver or spleen injury. Emergency laparotomy revealed complete disruption of the SMV across the site of confluence with the splenic vein. We performed primary reconstruction by connecting both ends of the vein as an end-to-end anastomosis. Following restoration of gastrointestinal passage the patient was discharged in good health. At his 6-month follow-up, angio-CT showed an unobstructed SMV and portal vein. There was slight stenosis at the site of the suture and no sign of development of collateral venous circulation into the liver. This case report shows that primary repair of an SMV injury can be done in a stable patient without concomitant life-threatening injuries once proximal and distal control of bleeding has been achieved. Ligation should be reserved for patients with multiple injuries and an unstable condition.     

Pulmonary Vein Thrombosis Treated Successfully by Thrombectomy After Bilateral Sequential Lung Transplantation: Report of a Case

We report the case of a 35-year-old man in whom an acute pulmonary vein thrombosis developed following bilateral sequential lung transplantation for cystic fibrosis. The thrombus was detected by transesophageal echocardiography 12 h after transplantation and an emergency thrombectomy was successfully performed. Received: March 29, 2002 / Accepted: September 3, 2002 Reprint requests to: I. Nagahiro     

Push-Up Exercise Induced Thrombosis of the Subclavian Vein in a Young Woman: Report of a Case

Deep venous thrombosis (DVT) is common, but only 2%–4% of DVTs involve the upper extremities (Roos in Am J Surg 154:568–73, 1987). Upper extremity DVT has a primary or secondary cause, and primary thrombosis is much rarer than secondary thrombosis. Primary upper extremity DVT comprises effort venous thrombosis and idiopathic thrombosis. Effort subclavian venous thrombosis, also called Paget–Schroetter syndrome, is an uncommon entity, which usually develops after strenuous effort of the upper extremities. Effort thrombosis of the upper extremity has been described in athletes involved in a wide variety of sports, including ball games, combatant sport and heavy athletics, games with rackets or clubs, and aquatic sports (Zell et al. in Angiology 52:337–42, 2001). Push-up exercise is a strengthening exercise for building up strength and endurance in the muscles of the upper arm and shoulders. It is also considered to be a core exercise in shoulder rehabilitation programs to activate the serratus anterior muscle in people with shoulder dysfunction (Ludewig et al. in J Sports Med 32:484–93, 2004). We report what to our knowledge is the first case of effort DVT of an upper extremity caused by push-up exercise.     

Prepancreatic Postduodenal Portal Vein: Report of a Case

We report an unusual case of a prepancreatic postduodenal portal vein (PPPV), incidentally discovered during total gastrectomy. If it had not been noticed, this portal vein might have been ligated and divided with disastrous consequences. This anomaly was not diagnosed preoperatively, but it could have been. Although embryological anomalies of the portal venous system, such as PPPV and preduodenal portal vein, are rarely encountered in abdominal surgery, surgeons must be aware of their possibility and be able to recognize them to avoid major intraoperative injury.     

原发性肝癌切除术后门静脉血栓形成的预防及治疗

目的探讨原发性肝癌切除术后门静脉血栓形成的可能原因及防治方法。方法回顾分析我科自2013年1月~2014年10月8例原发性肝癌患者行肝部分切除术后门静脉血栓形成的临床资料,包括患者的一般资料、手术部位、术后临床化验指标、相关的影像学检查结果、临床处理及预后。结果原发性肝癌切除术后门静脉血栓形成的发生率为2.05%(8/389),均发生在术后10天内,临床表现以腹胀、腹部不适、腹水形成、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素和乳酸脱氢酶在短时间内急剧升高为初发表现。除3例门静脉血栓早期予抗凝、溶栓治疗后存活;其余5例门静脉主干血栓者经抗凝及溶栓治疗无效,均于血栓形成2周左右死亡。结论门静脉血栓形成是原发性肝癌切除术后一种少见的,但却是相当的严重的并发症,其确切的发病机制、有效的预防及治疗方法需重视和进一步研究。     

Ten-Year Experience in Porto-Caval Hemitransposition for Liver Transplantation in the Presence of Portal Vein Thrombosis

Porto-caval hemitransposition (PCH) in liver transplantation allows revascularization of the liver when the porto-mesenteric axis is thrombosed. We, here, review our experience over an 11-year period. A total of 23 patients underwent liver transplantation using PCH. Immunosuppression was based on tacrolimus, with sirolimus used in case of renal insufficiency. Most common diagnoses were hepatitis C, Laennec's, Budd-Chiari and cryptogenic cirrhosis. Six patients needed splenectomy prior to transplant, 5 during transplant, 1 post-transplant, 11 had no splenectomy. Overall survival was 60% at 1 year and 38% at 3 years, with 10 of 23 patients currently alive and the longest survivor at 9.3 years. Most common cause of death was sepsis/multisystem organ failure, followed by pulmonary embolism. A total of 7/23 patients experienced post-operative gastrointestinal bleeding episodes, 6/23 patients developed thrombosis of the vena cava (median 162 days post-op). Post-operative ascites was noted in almost all patients. Renal dysfunction was commonly seen even after the first month post-transplant. PCH offers a feasible option for liver transplantation in those patients with complex thrombosis of the mesenteric and portal circulation.     

Mesenteric Paraganglioma: Report of a Case

We report a rare case of a solitary primary paraganglioma arising in the mesentery, found in a 72-year-old woman who presented with abdominal pain and a palpable abdominal mass. This extra-abdominal paraganglioma developed from paraganglionic cells that travelled by vertebral migration from the root of the superior mesenteric artery. Extra-adrenal paraganglia extend anywhere from the neck down to the base of the pelvis. Ultrasonography, computed tomography (CT), and angiography showed a solid and cystic heterogeneously enhanced mass, which was fed by the superior mesenteric artery, without distant metastasis. Exploratory laparotomy revealed a large, dark, brownish-red mass in the mesentery of the ileum, which was distinct from the ileum. The mass consisted of peripherally solid areas with central hemorrhage and cystic degeneration. It was diagnosed as a paraganglioma histologically. The patient is free from recurrence of paraganglioma after 1 year of follow up. To our knowledge, this represents only the seventh case of a paraganglioma arising in the mesentery.     

Portal Vein Resection for a Portal Vein Thrombus Caused by Nonfunctioning Islet Cell Carcinoma: Report of a Case

We report a case of nonfunctioning islet cell carcinoma of the pancreas causing a tumor thrombus in the portal vein. The patient was a 60-year-old woman whose presenting symptoms were abdominal pain, vomiting, and weight loss. We performed a subtotal pancreatectomy and splenectomy combined with partial resection of the portal vein. Histopathological studies confirmed the diagnosis of nonfunctioning islet cell carcinoma of the pancreas with a tumor thrombus in the portal vein. The patients postoperative course was uneventful and she is doing well 25 months after the operation.     

急性肠系膜上静脉血栓形成35例分析

目的：探讨急性肠系膜上静脉血栓形成的病因、临床表现及诊断治疗。方法：35例急性肠系膜上静脉血栓形成患者中26例确诊后给予抗凝溶栓治疗。9例确诊后即行手术治疗,均行小肠部分切除术,术后继续抗凝治疗。结果：抗凝溶栓组26例中22例治愈,5例出院后于两年内复发再次入院治疗,4例中转手术,1例术后死亡。急症手术组9例治愈8例,术后死亡1例。结论：急性肠系膜上静脉血栓形成与腹部手术、高凝状态及门脉高压有关。腹部强化CT检查,早期诊断并抗凝溶栓治疗,可取得较好的疗效。手术时机把握合适,术中正确判断切除坏死肠管范围及术后抗凝治疗,是降低死亡率的关键。     

Isolated Superficial Sylvian Vein Thrombosis with Long Cord Sign: Case Report and Review of the Literature

Isolated cortical vein thrombosis (ICVT) is extremely rare. Only single case or small series of ICVT have been reported; clinical details are still uncertain. We report a case of isolated superficial sylvian vein thrombosis with exceedingly long cord sign. A 14-year-old female with severe sudden onset headache visited our hospital. Fluid attenuated inversion recovery and echo-planar T₂* susceptibility-weighted imaging (T₂*SW) showed a long cord sign on the surface of the sylvian fissure. The patency of dural sinuses and deep cerebral veins were confirmed by magnetic resonance venography (MRV), and diagnosis of ICVT was made. She recovered completely without anticoagulant agents. To clarify the clinical characteristics of ICVT, we reviewed 51 ICVT cases in the literature. In many cases, T₂*SW was the most useful examination to diagnose ICVT. In contrast with general cerebral venous thrombosis, MRV and conventional angiography were either supporting or useless. Anastomotic cortical veins were involved frequently; symptoms of gyri around the veins were common. It also suggested that ICVTs of the silent area might have been overlooked because of nonspecific symptoms, and more patients with ICVT may exist. In cases involving patients with nonspecific symptoms, the possibility of ICVT should be considered.     

肝移植围手术期门静脉栓塞的诊断和处理

目的探讨肝移植围手术期合并门静脉血栓或癌栓的诊断及处理。方法回顾性分析1999年10月至2006年1月期间8例施行肝移植的终末期肝病伴门静脉血栓或癌栓患者的临床资料及生存情况。结果61例肝移植患者中,8例合并门静脉血栓或癌栓(13.1%),其中Ⅰ级3例,Ⅱ级5例,术前均明确诊断,术中6例行栓子取出,2例行病变段切除,门静脉端端吻合术,术后均给予抗凝治疗。术后6个月存活率为62.5%。结论准确的术前诊断、正确的术式选择和合理的术后治疗对肝移植围手术期门静脉血栓或癌栓的患者有很大意义。     

Thrombosis of the Left Brachiocephalic Vein After Subtotal Esophagectomy with Reconstruction Using a Retrosternally Shifted Gastric Tube: Report of a Case

We performed a right transthoracic subtotal esophagectomy with systemic three-field lymph node dissection, followed by reconstruction with a gastric tube shifted retrosternally into the left side of the neck, for esophageal cancer in a 62-year-old woman. The patient had an uneventful postoperative course until postoperative day (POD) 9, when a venous thrombosis originating from the left brachiocephalic vein and elongating to the left subclavian vein was detected occasionally on computed tomography scans, although there were no clinical symptoms. The left brachiocephalic vein seemed narrowed by compression from the reconstructed gastric tube, and this was considered the cause of the thrombosis. The patient was commenced on thrombolytic therapy, using urokinase, and on anticoagulation therapy, using heparin and warfarin. The thrombus had disappeared completely by POD 38. The anticoagulation therapy was continued for 6 months and no recurrence of the thrombosis has been detected in the 4 months since its completion.