Abstract
Portal vein thrombosis is a condition when the thrombus is blocking or nar-rowing blood flow of the portal vein. The initial approach in diagnosis of portal vein thrombosis for a non-transportable critically ill patient is a colour Doppler ultrasonography. We present a case of an 82-year-old female with partial portal vein thrombosis following urgent cholecystec-tomy and choledochotomy. The clinical deterioration of the patient with hemo-dynamic and respiratory instability, acute renal failure, liver damage and metabolic acidosis, prevented the patient’s transport for computed tomography diagnostics. A bedside abdominal ultrasonography was performed and revealed a partial obstruc-tion of the left branch of the portal vein, while a confluent part of the portal vein showed a complete absence of flow. Thera-py with low molecular weight heparin was immediately started. Definitive confirma-tion of portal vein thrombosis with the ab-dominal computed tomography imaging was possible almost 24 hours after clinical and laboratory deterioration. This case il-lustrates the importance of rapid bedside ultrasonography in diagnosis of thrombo-embolic events in the abdomen.
Highlights
Portal vein thrombosis (PVT) is a condition when the thrombus in a portal vein causes a partial or total obstruction to the blood flow
An 82-year-old female was admitted to the Intensive Care Unit (ICU) following urgent cholecystectomy and choledochotomy, due to acute cholecystitis and choledocholithiasis
Delay in the low molecular weight heparin (LMWH) administration in therapeutic doses could increase the thrombotic occlusion of portal vein and other abdominal vessels or initiate pulmonary embolism
Summary
Portal vein thrombosis (PVT) is a condition when the thrombus in a portal vein causes a partial or total obstruction to the blood flow. It is a relatively uncommon surgical complication, reported in literature mostly after laparoscopic procedures, liver transplantation or splenectomy. An 82-year-old female was admitted to the Intensive Care Unit (ICU) following urgent cholecystectomy and choledochotomy, due to acute cholecystitis and choledocholithiasis Her past medical history included stabile angina, hypertension, three coronary artery bypass grafts and one stent. Despite generous volume therapy and diuretic stimulation, she was anuric, and continuous haemodialysis was necessary At that moment, her hemodynamic status improved and a CT angiography was performed. Her clinical condition eventually deteriorated again, and she died of multiple organ failure
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