Abstract
Portal vein thrombosis (PVT) is characterized by the obstruction of the portal venous system. The venous obstruction can be partial or complete and it is caused by thrombogenic conditions (acquired or hereditary) or nonthrombotic factors. The acquired conditions include abdominal inflammation, infections, surgery, myeloproliferative disorders, obesity, oral contraceptive intake, pregnancy, and postpartum period. Occasionally, it is not possible to recognize any overt cause of PVT. During pregnancy there is an increased venous thromboembolism risk mainly in the systemic venous system and the PVT can occur, but there are no data about its exact prevalence, etiology, and outcome. The portal cavernoma is the cavernomatous transformation of the portal vein. It is a consequence of chronic PVT and occurs when myriads of collateral channels develop to bypass the occlusion. The clinical presentation includes hematemesis due to variceal bleeding, ascites or anaemia, and splenomegaly. The cavernous transformation of the portal vein is easily diagnosed by sonography. We report our case of a 32-year-old, gravida 3 para 2, pregnant woman admitted to our hospital at 13 weeks and 1 day of gestation, clinically asymptomatic. Laboratory test, ultrasound, and endoscopic evaluation were negative. After a detailed counseling, the patient decided on termination of pregnancy at 15 weeks and 1 day of gestation.
Highlights
Portal vein thrombosis (PVT) is characterized by the obstruction of the main portal vein and/or its left or right branches
During pregnancy there is an increased venous thromboembolism risk, mainly in the systemic venous system and the portal vein thrombosis can occur, but in the literature there are no data about its exact prevalence, etiology, and outcome, and no definite guidelines for the management of this condition during pregnancy are available
Two large studies on pregnant women with chronic PVT revealed that variceal bleeding is the most common clinical complication followed by thrombosis, abdominal pain, jaundice, and incidental splenomegaly [1, 2]
Summary
Portal vein thrombosis (PVT) is characterized by the obstruction of the main portal vein and/or its left or right branches. During pregnancy there is an increased venous thromboembolism risk, mainly in the systemic venous system and the portal vein thrombosis can occur, but in the literature there are no data about its exact prevalence, etiology, and outcome, and no definite guidelines for the management of this condition during pregnancy are available. Two large studies on pregnant women with chronic PVT revealed that variceal bleeding is the most common clinical complication followed by thrombosis, abdominal pain, jaundice, and incidental splenomegaly [1, 2]. Pregnancy is characterized by a hypervolemic state that causes an increase in the portal flow, which contributes to high portal pressure that is transmitted to the upper gastrointestinal collateral veins and increases the risk of variceal bleeding [3]. The report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT
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