Heparin-perfusion therapy for thrombosis of the intra- and extrahepatic portal and mesenteric vein.

Abstract Background:Although as stated many times in the literature, the initial treatment of acute and subacute portal vein thrombosis (PVT) consists of intravenous anticoagulation with heparin, but there is still a huge uncertainty among physicians regarding whether the patient should be better taken to more invasive therapies. Case Presentation:We henceforth report on a 61-year-old patient, who presented in our emergency room with a subacute thrombosis of the intra- and extrahepatic portal and superior mesenteric vein (SMV) and venous congestion of 20-30 cm of the small intestine with a quick and complete remission of the PVT under sole i.v. Heparin-perfusor therapy with repetitive CT-follow-ups without any complications. Molecular genetic analysis found combined genetic mutations of the gene factor 2 (c.20210G>A, heterozygotic), SERPINE1 (-675 5G>4G, heterozygotic), and the MTHFR gene.Conclusion:Early diagnosis and immediate initiation of heparinization in patients with PVT and SMVT, could not only reverse the initial intestinal ischemia but also suffice as the sole mode of treatment, preventing the subsequent need for radiological and surgical interventions. Furthermore, molecular genetic counseling should be always taken under consideration when the cause of PVT remains unknown