Chiu YC, Chang WC, Chiu YC. Early catheter-directed portal vein thrombolysis in myeloproliferative disorder-related diffuse mesenteric venous ischemia: A case report. World J Gastroenterol 2026; 32(4): 114906 [DOI: 10.3748/wjg.v32.i4.114906]
Corresponding Author of This Article
Yu-Cheng Chiu, MD, Chief Physician, Department of Trauma and General Surgery, Tri-Service General Hospital, No. 325 Section 2, Chenggong Road, Taipei 114, Taiwan. agaukysr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 28, 2026; 32(4): 114906 Published online Jan 28, 2026. doi: 10.3748/wjg.v32.i4.114906
Early catheter-directed portal vein thrombolysis in myeloproliferative disorder-related diffuse mesenteric venous ischemia: A case report
Ya-Chin Chiu, Wei-Chou Chang, Yu-Cheng Chiu
Ya-Chin Chiu, Department of General Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
Wei-Chou Chang, Department of Radiology, Tri-Service General Hospital, Taipei 114, Taiwan
Yu-Cheng Chiu, Department of Trauma and General Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
Author contributions: Chiu YC drafted the manuscript; Chiu YC revised the manuscript and supervised the study as the attending physician; Chang WC provided interventional radiology consultation and technical support; all authors read and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
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: Yu-Cheng Chiu, MD, Chief Physician, Department of Trauma and General Surgery, Tri-Service General Hospital, No. 325 Section 2, Chenggong Road, Taipei 114, Taiwan. agaukysr@gmail.com
Received: October 11, 2025 Revised: November 23, 2025 Accepted: December 18, 2025 Published online: January 28, 2026 Processing time: 113 Days and 5.3 Hours
Abstract
BACKGROUND
Portal vein thrombosis (PVT) is a rare condition and is often associated with cirrhosis, malignancy, or prothrombotic states. Currently, systemic anticoagulation is the standard to treat PVT. The role of alternative treatments are currently under investigation. In particular direct thrombolysis for the treatment of nonmalignant PVT is controversial due to the risk of bleeding. Here we have reported a case highlighting therapeutic considerations and outcomes of direct thrombolysis.
CASE SUMMARY
A 67-year-old male without a prior history of cirrhosis or malignancy presented with acute abdominal pain and peritonitis. Contrast-enhanced computed tomography revealed complete thrombosis of the portal vein with extension into the superior mesenteric vein. These findings were consistent with impending mesenteric ischemia. Despite systemic anticoagulation the patient’s symptoms progressed. Urgent catheter-directed thrombolysis via a transhepatic approach was initiated using continuous urokinase infusion. We observed substantial thrombus regression and resolution of ischemic symptoms, thereby avoiding surgical intervention. Subsequent hematologic evaluation revealed a JAK2 V617F mutation-associated polycythemia vera as the underlying prothrombotic disorder.
CONCLUSION
Early low-dose catheter-directed thrombolysis provided a safe and effective treatment for a patient with noncirrhotic, nonmalignant PVT associated with mesenteric ischemia, demonstrating the utility of an alternative treatment for PVT.
Core Tip: Systemic anticoagulation is currently the first-line treatment for noncirrhotic portal vein thrombosis, and endovascular therapy typically reserved as a rescue option. Early direct thrombolysis with lower doses achieved good recanalization and a low risk of bleeding for our patient. However, the optimal therapeutic dose range requires further investigation.
