LYSIS OF A SEPTIC THROMBUS OF THE PORTAL-VEIN WITH ULTRA-HIGH DOSES OF STREPTOKINASE

Eight days after an appendicectomy a 40-year-old man developed a fever of up to 40.5-degrees-C. The concentration of the transaminases was elevated (GOT 61 U/l, GPT 115 U/l, gamma-GT 226 U/l). Operative revision discovered no unusual wound conditions. Ultrasonography revealed splenomegaly (15 x 7 cm) and dilatation of the portal vein (diameter of 19 mm). The portal vein contained echo-dense constituents indicating thrombosis. Colour Doppler duplex sonography recorded only minimal residual flow around the thrombus. The fever gradually subsided under antibiotic treatment (metronidazole, 500 mg twice daily; mezlocillin, 2 g three times daily; later also gentamicin, 80 mg three times daily). Blood culture grew Bacteroides fragilis. 14 days after the wound revision ultra-high short-term lysis with streptokinase was instituted (9 mill IU over 6 hours), followed by heparin i.v. 25,000-30,000 i.v. daily for 5 days. 12 hours after the start of thrombolysis treatment the portal vein thrombus had been dissolved,and after 8 days the size of the spleen was normal.