Asian EUS Cup-06: Diagnosis and treatment of recurrent upper gastrointestinal bleed with endoscopic ultrasound (gastric varix with splenic artery aneurysm)

S43 ENDOSCOPIC ULTRASOUND / VOLUME 6 / SUPPLEMENT 1 / AUGUST 2017 Asian EUS Cup-04 Endoscopic ultrasound-guided continuous catheter thrombolysis of portal venous system Malay Sharma, Piyush Somani, Saurabh Jindal Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India Background: Acute portal vein thrombosis is an uncommon and insidious disease that is potentially lethal due to delay in diagnosis and therapy. There are no uniform protocols for the effective treatment of acute portal vein thrombosis. Case Report: An 18-year-old female presented with intractable upper abdominal pain and vomiting. Abdominal ultrasound, computed tomography scan, and magnetic resonance image showed extensive thrombosis of portal venous system without bowel infarction. A diagnosis of acute portal vein thrombosis was made, and she was started on anticoagulants. The intractable pain persisted and endoscopic ultrasound (EUS)-guided thrombolysis was planned. A window of patent superior mesenteric vein (SMV) was selected for EUS-guided puncture. The puncture was made through the pancreas into SMV with a 22-gauze EUS-guided fine needle aspiration needle. A 0.018 guidewire was placed into a tributary of SMV. A tapered tip cannula was advanced over the wire, and cannula was positioned in the vein. The cannula was routed through the nose and a syringe pump was fitted for infusion of thrombolytic agent. Continuous catheter-guided thrombolytic therapy was started with streptokinase at a dose of 30,000 IU/h with systemic anticoagulation with low molecular weight heparin. Her prothrombotic workup suggested deficiency of protein C and protein S. The patient was discharged on the 7th day with a satisfactory clinical and radiological response. A follow-up after 3 weeks showed flow in splenic and portal vein. Conclusion: EUS-guided continuous catheter thrombolysis may be tried in life-threatening acute portal vein thrombosis. DOI: 10.4103/2303-9027.212293