Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 1082-1085
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1082
Successful treatment of acute symptomatic extensive portal venous system thrombosis by 7-day systemic thrombolysis
Fang-Bo Gao, Le Wang, Wen-Xiu Zhang, Xiao-Dong Shao, Xiao-Zhong Guo, Xing-Shun Qi
Fang-Bo Gao, Le Wang, Wen-Xiu Zhang, Xiao-Dong Shao, Xiao-Zhong Guo, Xing-Shun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Fang-Bo Gao, Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
Author contributions: Qi XS conceived this manuscript; Zhang WX, Guo XZ, and Qi XS treated this case; Gao FB, Wang L, and Qi XS followed this case; Gao FB and Qi XS drafted the manuscript; Gao FB, Wang L, Zhang WX, Shao XD, Guo XZ, and Qi XS revised the manuscript; all authors have made an intellectual contribution to the manuscript and approved the submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Shun Qi, MD, PhD, Associate Professor, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. xingshunqi@126.com
Received: April 29, 2022
Peer-review started: April 29, 2022
First decision: May 29, 2022
Revised: June 1, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: September 27, 2022

Acute portal venous system thrombosis (PVST) can cause acute mesenteric ischemia and even intestinal infarction, which are potentially fatal, and requires recanalization in a timely fashion. Herein, we report a 56-year-old man with acute non-cirrhotic symptomatic extensive PVST who achieved portal vein recanalization after systemic thrombolysis combined with anticoagulation. Initially, anticoagulation with enoxaparin sodium for 4 d was ineffective, and then systemic thrombolysis for 7 d was added. After that, his abdominal pain completely disappeared, and portal vein system vessels became gradually patent. Long-term anticoagulation therapy was maintained. In conclusion, 7-d systemic thrombolysis may be an effective and safe choice of treatment for acute symptomatic extensive PVST which does not respond to anticoagulation therapy.

Keywords: Portal vein, Mesenteric vein, Thrombosis, Thrombolysis, Anticoagulation, Deep vein thrombosis

Core Tip: The present case suggests that systemic thrombolysis should be safe and effective for acute extensive portal venous system thrombosis, if it is unresponsive to anticoagulation.