Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1876-1882
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1876
Transileocolic endovascular treatment by a hybrid approach for severe acute portal vein thrombosis with bowel necrosis: Two case reports
Sayaka Shirai, Tatsuo Ueda, Fumie Sugihara, Daisuke Yasui, Hidemasa Saito, Hiroyasu Furuki, Shiei Kim, Hiroshi Yoshida, Shoji Yokobori, Hiromitsu Hayashi, Shin-ichiro Kumita
Sayaka Shirai, Tatsuo Ueda, Fumie Sugihara, Hidemasa Saito, Hiromitsu Hayashi, Shin-ichiro Kumita, Department of Radiology, Nippon Medical School Hospital, Bunkyo-ku 113-8603, Tokyo, Japan
Daisuke Yasui, Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki-shi 211-8533, Kanagawa, Japan
Hiroyasu Furuki, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tamanagayama Hospital, Tama-shi 206-8512, Tokyo, Japan
Shiei Kim, Shoji Yokobori, Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku 113-8603, Tokyo, Japan
Hiroshi Yoshida, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Hospital, Bunkyo-ku 113-8603, Tokyo, Japan
Author contributions: Shirai S, Ueda T, Sugihara F, Yasui D, Saito H, Furuki H, Kim S, and Yoshida H performed treatment and drafted the manuscript; Yokobori S, Hayashi H, and Kumita SI drafted the manuscript.
Informed consent statement: The patients gave their written informed consent for the publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Tatsuo Ueda, MD, PhD, Senior Lecturer, Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo, Bunkyo-ku 113-8603, Tokyo, Japan. s9015@nms.ac.jp
Received: July 5, 2021
Peer-review started: July 5, 2021
First decision: October 11, 2021
Revised: October 22, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 26, 2022
Abstract
BACKGROUND

Acute portal vein thrombosis (PVT) with bowel necrosis is a fatal condition with a 50%-75% mortality rate. This report describes the successful endovascular treatment (EVT) of two patients with severe PVT.

CASE SUMMARY

The first patient was a 22-year-old man who presented with abdominal pain lasting 3 d. The second patient was a 48-year-old man who presented with acute abdominal pain. Following contrast-enhanced computed tomography, both patients were diagnosed with massive PVT extending to the splenic and superior mesenteric veins. Hybrid treatment (simultaneous necrotic bowel resection and EVT) was performed in a hybrid operating room (OR). EVTs, including aspiration thrombectomy, catheter-directed thrombolysis (CDT), and continuous CDT, were performed via the ileocolic vein under laparotomy. The portal veins were patent 4 and 6 mo posttreatment in the 22-year-old and 48-year-old patients, respectively.

CONCLUSION

Hybrid necrotic bowel resection and transileocolic EVT performed in a hybrid OR is effective and safe.

Keywords: Bowel necrosis, Endovascular treatment, Hybrid operating room, Hybrid treatment, Portal vein thrombosis, Transileocolic approach, Case report

Core Tip: Acute portal vein thrombosis (PVT) with bowel necrosis is a fatal condition with no definite cure. This report describes successful endovascular treatment (EVT) in two severe PVT cases. Hybrid treatment (simultaneous necrotic bowel resection and EVT) was performed in a hybrid operating room. EVTs, including aspiration thrombectomy, catheter-directed thrombolysis (CDT), and continuous CDT, were performed via the ileocolic vein under laparotomy. By performing this procedure, we were able to achieve a good result for a disease with a low survival rate and did so with minimal intestinal resection.