Successful Multimodal Interventional Management of Extensive Portal Venous System Thrombosis in a Patient with a Hypercoagulable State

We present a case of extensive mesenteric and portal vein thrombosis in a 59-year-old male with a history of multiple thrombotic events and hypercoagulable conditions. The patient presented with abdominal pain, nausea, vomiting, and black stools, leading to the discovery of thrombosis in the portal vein, splenic vein, and superior mesenteric vein (SMV) with associated bowel ischemia. The goal of treatment was to prevent mesenteric ischemia, maintain portal vein patency, and preserve options for potential liver transplantation. The case was managed through a combination of ultrasound-guided paracentesis, portal and SMV venography, mechanical thrombectomy using the AngioJet device, and continuous thrombolytic therapy. Initial intervention reduced thrombus burden; however, residual thrombus necessitated ongoing thrombolysis. Follow-up venograms showed improved patency in the portal vein and SMV with significant resolution of the thrombus.