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Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis

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Background Acute venous mesenteric ischaemia is rare and there is no standard conservative or operative treatment.

Methods The results of surgical treatment for acute mesentericoportal thrombosis were retrospectively analysed in 31 patients. The thrombotic occlusion affected the superior mesenteric vein in 19 patients, the portal vein in eight and both vessels in four. Surgical treatment comprised venous thrombectomy (nine patients), bowel resection (17), a combination of thrombectomy and bowel resection (two), distal splenorenal shunt (one) and simple laparotomy (two).

Results When the mesentericoportal blood flow was restored, the mortality rate was lower, but not significantly so, than after bowel resection alone (two of nine versus seven of 17). In addition to thrombectomy, local thrombolysis with recombinant tissue plasminogen activator was performed in five patients via a catheter placed into a distal mesenteric vein and all survived. The overall hospital mortality rate was 11 (35 per cent) of 31.

Conclusion An active approach should be encouraged in patients with this condition employing thrombectomy in addition to bowel resection. Early results are encouraging and local thrombolysis warrants further study.
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Document Type: Research Article

Affiliations: Department of Abdominal and Transplantation Surgery, Hanover Medical School, Hanover, Germany

Publication date: January 1, 1997

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