Recombinant Tissue Plasminogen Activator (rTPA) in the Treatment of Superior-Mesenteric Vein Thrombosis

Abstract

A fifty-two-year-old woman presented with an acute abdomen. Operation revealed hemorrhagic infarction of the small intestine from the duodenojejunal flexure to the ileocecal junction, the gut being deeply blue. Weak pulses were palpable in the upper mesenteric artery, but no blood flow was detectable in the vein. Since the gut did not recover, the authors performed arteriotomy and injected 10 mg of recombinant tissue plasminogen activator as a bolus. Another 90 mg was infused over the following ninety minutes. The laparotomy wound was temporarily closed. Reopening of the abdomen twelve, thirty-six, and seventy-two hours later revealed stepwise recovery of the small intestine. The patient left the hospital twenty-two days later. From this experience the authors recommend that thrombolysis be attempted in far-reaching hemorrhagic infarc tion of the small intestine.