Portal vein thrombosis 22/6/2 -> f/u

M/55  15095092

응급실 기록

abd pain

# cholecystectomy history

상환 전일부터 발생한 abd pain 주소로

local에서 ct촬영후 SMV thrombosis, portal vein thrombosis 진단받아 응급실로 내원함.

epigastric, RUQ, LUQ Td (+), rTd (-) a/n/v/d/c/ -/-/-/-/-

 

CTVR) main portal vein뿐만 아니라 segmental vein 에도 thromobosis관찰, ischemia 심한정도로 판단, extent 도 넓음.

 

응급실 검사

WBC Count                    15.59            ▲

CRP (C-Reactive Protein), quan.  60.49            ▲

Fibrinogen                   613.0            ▲      mg/dl            175~360
   D-dimer                      8.91             ▲      mg/L FEU         <0.76

 

> CT Reading Outside Films(Abdomen)  [검사일시:2022-06-27 16:17] GS (박선민)
[FINDING]
S/P cholecystectomy.

Long segmental venous thrombus is noted in SMV and its branch and main portal vein. 

Ileum shows target appearance wall thickening.

Mesenteric fat haziness and small amount of ascites are visible. No extraluminal gas is demonstrated. Fatty liver is noted without focal lesion. Bile duct is not dilated. The pancreas, spleen and both kidneys show no particular abnormality.

[CONCLUSION]
1. Diffuse venous thrombus in SMV and its branches and main portal vein.
2. Small bowel ischemia.
3. Fatty liver.

 

환자의 portal vein thrombosis VS 정상 portal vein (enhance 되어있다)

RED : ischemic small bowel / BLUE : normal wall enhancement

Ileum&nbsp;shows&nbsp;target&nbsp;appearance&nbsp;wall&nbsp;thickening .

OP 기록

Lap. small bowel segment resection

mini-laparotomy -small bowel을 incision site 밖으로 꺼내어 ischemic change 부위를 확인함

-ischemic chagne length : 55cm anastomosis

-Linear stapler 100mm

-lambert suture done

-> 의뢰 : thrombosis 유발 원인 검사 IMC, IMZ(auto immune disease)