Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery

A 32-year-old man, who was previously healthy, had acute abdominal pain wit hout peritonitis. Diffuse mesenteric and portal vein thrombosis were shown by means of a computed tomography scan. A protein S deficiency was found by means of an extensive workup for hypercoagulable state. Successful treatme nt was achieved with urokinase infusion via the superior mesenteric artery without an operation. This represents an attractive alternative approach to treating patients with this disease. The previous standard of operative in tervention(1) can now be reserved for complications, such as bowel infarcti on with peritonitis, or for those patients with absolute contraindications to thrombolytic therapy.