Early catheter-directed portal vein thrombolysis in myeloproliferative disorder-related diffuse mesenteric venous ischemia: A case report.

BACKGROUND: Portal vein thrombosis (PVT) is a rare condition and is often associated with cirrhosis, malignancy, or prothrombotic states. Currently, systemic anticoagulation is the standard to treat PVT. The role of alternative treatments are currently under investigation. In particular direct thrombolysis for the treatment of nonmalignant PVT is controversial due to the risk of bleeding. Here we have reported a case highlighting therapeutic considerations and outcomes of direct thrombolysis.

CASE SUMMARY: A 67-year-old male without a prior history of cirrhosis or malignancy presented with acute abdominal pain and peritonitis. Contrast-enhanced computed tomography revealed complete thrombosis of the portal vein with extension into the superior mesenteric vein. These findings were consistent with impending mesenteric ischemia. Despite systemic anticoagulation the patient's symptoms progressed. Urgent catheter-directed thrombolysis via a transhepatic approach was initiated using continuous urokinase infusion. We observed substantial thrombus regression and resolution of ischemic symptoms, thereby avoiding surgical intervention. Subsequent hematologic evaluation revealed a JAK2 V617F mutation-associated polycythemia vera as the underlying prothrombotic disorder.

CONCLUSION: Early low-dose catheter-directed thrombolysis provided a safe and effective treatment for a patient with noncirrhotic, nonmalignant PVT associated with mesenteric ischemia, demonstrating the utility of an alternative treatment for PVT.