The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment by Transradial Urokinase Infusion and Percutaneus Transhepatic Thrombectomy in Superior Mesenteric Venous Thrombosis with Intestinal Infarction

장경색을 동반한 상장간막정맥 혈전증 환자에서 요골동맥을 통한 혈전 용해제 주입술과 경피적 혈전제거술로 치험 1예

  • Bae, Suk Hyang (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Kim, Kyung Han (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Whang, Jin Yeon (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Lee, Jeong Min (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Kim, Jeong Min (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Ku, Jeong Mo (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine) ;
  • Lee, Jonghun (Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine)
  • 배숙향 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 김경한 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 황진연 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 이정민 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 김정민 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 구정모 (동아대학교 의과대학 동아대학교병원 소화기내과) ;
  • 이종훈 (동아대학교 의과대학 동아대학교병원 소화기내과)
  • Received : 2013.02.13
  • Accepted : 2013.05.10
  • Published : 2018.02.01
⟨ Previous Next ⟩

Abstract

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.

간문맥 및 상장간막정맥의 광범위한 혈전증으로 인해 복막염 및 장경색의 징후를 보이는 환자에서 요골동맥을 통한 카테터를 이용하여 상장간막동맥으로 혈전 용해제를 주입하고 경피경간 문맥조영술을 이용하여 간문맥 및 상장간막정맥의 혈전제거술을 시행하여 광범위한 간문맥 및 상장간막정맥 혈전증을 성공적으로 치료한 1예를 경험하였다. 경색 및 복막염이 동반되어 수술 위험도가 클 경우 나이, 전신상태, 진단 시기, 혈전증의 원인 등을 고려해서 방사선 중재법 및 내과적 보존적 치료를 시도해 볼 수 있겠다.

Keywords

References

  1. Lee H, Kim TH, Oh HJ, et al. Portal and superior mesenteric venous thrombosis treated with urokinase infusion via superior mesenteric artery. Korean J Gastroenterol 2006;48:46-50.
  2. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001;345:1683-1688. https://doi.org/10.1056/NEJMra010076
  3. Choo KY, Choi SW, Yang JM, et al. A case of multiple mesenteric thrombosis in a patient with liver cirrhosis. Korean J Gastroenterol 1996;28:426-432.
  4. Woo JG, Lee JE, Kwon OU, et al. A case of superior mesenteric venous thrombosis due to protein C deficiency in a patient with duodenal ulcer bleeding. Korean J Gastroenterol 2011;57:34-37. https://doi.org/10.4166/kjg.2011.57.1.34
  5. Aliosmanoglu I, Gul M, Kapan M, et al. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg 2013;98:76-81. https://doi.org/10.9738/CC112.1
  6. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004;164:1054-1062. https://doi.org/10.1001/archinte.164.10.1054
  7. Alpern MB, Glazer GM, Francis IR. Ischemic or infarcted bowel: CT findings. Radiology 1988;166(1 Pt 1):149-152. https://doi.org/10.1148/radiology.166.1.3336673
  8. Kim HS, Patra A, Khan J, Arepally A, Streiff MB. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol 2005;16:1685-1691. https://doi.org/10.1097/01.RVI.0000182156.71059.B7
  9. Joh JH, Kim DI. Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 2005;29:204-208. https://doi.org/10.1016/j.ejvs.2004.10.005

Cited by

  1. Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience vol.64, pp.4, 2021, https://doi.org/10.5468/ogs.20374