Case Of Portal Vein Thrombosis Research Articles

Portal vein thrombosis as extraintestinal complications of Crohn’s disease: a case report and review of literature

IntroductionThrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn’s disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn’s disease, portal vein, and thrombosis.Case presentationA 24-year-old Syrian female with active chronic Crohn’s disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn’s disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization.ConclusionPortal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication.

Remarkable alpha-fetoprotein elevation and pseudo-infarction of cirrhotic liver: case report

This is a case of remarkable alpha-fetoprotein in a female patient with known cryptogenic liver cirrhosis. Both ultrasound and triphasic computed tomography (CT) abdomen cannot diagnose or exclude hepatocellular carcinoma (HCC). It turns out to be a case of portal vein thrombosis and hepatic pseudo-infarction. It is better to postpone the therapeutic intervention, whether surgical or chemotherapeutic, in cases not confirmed to be HCC for at least 3 months to avoid misdiagnosis of hepatic pseudo-infarction.

Acute Pancreatitis Complicated with Portal Vein Thrombosis: A Case Report and Literature Review

Objective: Rare co-existance of disease or pathology. Background: Portal vein thrombosis is an unusual clinical condition due to multiple etiological and morbidity factors. In some cases, Portal vein thrombosis remains undiagnosed and discovered incidentally during aregular check up for a known cause. Case Report: we report a rare case of portal vein thrombosis associated with acute pancreatitis of 58-year-old man. Conclusions: Although vascular complications such as Portal vein thrombosis after pancreatitis are exceptional. It should be expected in any patient with pancreatitis. These complications, if diagnosed and treated early, will significantly reduce morbidity and mortality.

Portal Vein Thrombosis in a Woman with a Large Uterine Fibroma

This article presents a case of portal vein thrombosis accompanied by a large uterine fibroma. A 37-year-old virgin woman presented with vaginal bleeding, abdominal mass, fever, dyspnea and lower limbs edema. In past medical history, she did not have any systemic diseases. She had menometrorrhagia from four years ago. She was admitted with diagnosis of a large uterine fibroma and was suspected of COVID 19 pneumonia or thrombophlebitis. The final diagnosis was a large uterine fibroma with chronic portal vein thrombosis. Although uterine fibromas are benign tumors, they may make serious life-threatening complications like thrombosis. The cause of thrombosis is the pressure effect of fibroma and/ or transfusion to treat anemia. Although there may be other unknown etiologies for thrombosis in these patients. We suggest that existence of a large uterine myomas should be known as a risk factor for thrombosis ( like IBS, Covid 19 and etc.) and be given a score in Caprini Score system, to start anticoagulation before and after any surgical intervention.

Percutaneous Direct Puncture of Retropancreatic Splenic Vein and Portal Thrombectomy in a Patient With Liver Transplantation and Simultaneous Splenectomy.

Portal vein thrombosis following liver transplantation is generally managed by endovascular treatment. Although several techniques are available for portal venous access, trans-splenic access is of interest because it avoids damage to the liver graft. However, the spleen cannot be punctured to access the portal vein after splenectomy. We herein report a case of portal vein thrombosis following living donor liver transplantation with simultaneous splenectomy successfully treated by percutaneous intervention with direct puncture of the retropancreatic splenic vein. The splenic vein was punctured under computed tomography guidance in the prone position. Portal venography revealed a contrast defect due to a thrombus in the extrahepatic to intrahepatic portal vein. The portal vein was reopened after thrombectomy, and the portal vein thrombosis did not recur for 2 y. The technique and advantages of our approach are described.

S3265 A Case of Portal Vein Thrombosis Following COVID Vaccination

Introduction: We present a case of portal vein thrombosis in a patient following COVID vaccination. Case Description/Methods: A 44-year-old female with a past medical history of type 2 diabetes mellitus, GERD, tobacco use, asthma, chronic migraines without aura, and COVID infection presents to the emergency department with a one-week history of abdominal pain, back pain, and black stools. She is hemodynamically stable and afebrile. Her labs are significant for elevated AST and ALT at 78 and 200 respectively. CT abdomen/pelvis with IV contrast is obtained and reveals hepatic infarcts with right portal vein thrombosis. She is subsequently started on a heparin drip for treatment. Esophagogastroduodenoscopy reveals gastritis and a 5 mm ulcer in the antrum which is not actively bleeding. Antiphospholipid antibody panel and activated protein C resistance lab results are unremarkable. On further history, the patient reports that she received her first dose of the Moderna COVID vaccine about three weeks prior to presentation. Per gastroenterology, she is able to go home on apixaban 5 mg twice a day for anticoagulation. Follow-up CT abdomen/pelvis three weeks after admission displays significantly improved enhancement pattern throughout the liver with minimal residual heterogeneous enhancement. The patient reports improvement in her abdominal pain during follow-up appointments, and her liver enzymes are trending back to normal levels. She follows up outpatient with hematology/oncology, however her hypercoagulable lab work-up continues to be unremarkable. Discussion: This case demonstrates that portal vein thrombosis may occur following COVID vaccination. The timeline of her developing portal vein thrombosis soon after receiving the COVID vaccination may be suggestive of the vaccine precipitating her condition. This patient did have an additional risk factor of tobacco use. This can be a challenging situation for many clinicians to navigate, as COVID remains a significant threat to patients’ health. Patients with hypercoagulable risk factors may benefit from close monitoring for abdominal pain or other symptoms surrounding COVID vaccination.

S2992 Extensive Portomesenteric Venous Thrombosis Due to JAK2 V617F Mutation as an Indication for Multivisceral Transplantation

Introduction: Cavernous transformation of the portal vein (CTPV) involving periportal or intrahepatic venous collateral network is a sequelae of chronic portal vein thrombosis (PVT). This adaptation increases the risk of complications and poor outcomes from revascularization procedures. In cases with diffuse portomesenteric venous thrombosis, multivisceral transplantation (MT) may be indicated. Case Description/Methods: An otherwise healthy female was diagnosed with Janus kinase 2 V617F (JAK2) mutation at age 43 during work up for PVT of unknown etiology. Her disease progressed with bleeding esophageal varices, portal hypertensive gastropathy, and splenomegaly. Liver biopsy was negative for cirrhosis. Bone marrow biopsy was negative for leukemia or fibrosis. She developed mesenteric vein thrombosis (MVT) at age 45 and was started on rivaroxaban, but then transitioned to high dose enoxaparin due to worsening thrombus progression. At age 47 she underwent thrombolysis for new MVT. Four months later, on current presentation, she endorsed worsening abdominal pain. Physical exam demonstrated ascites and pitting lower extremity edema. Abdominal ultrasound with venous duplex demonstrated absent flow in the portal vein. Computed tomography angiography (CTA) revealed progressive portal, superior mesenteric, and splenic vein thromboses despite anticoagulation (AC) compliance. Transjugular intrahepatic portosystemic shunt (TIPS) procedure was unsuccessful. Post-procedure CTA demonstrated an enlarging hepatic hematoma treated by embolization (figure 1). AC was discontinued resulting in worsening clot burden and hepatic ischemia. Given the extent of clot burden, the patient was transferred to another facility for a MT. Discussion: Presented is a rare case of chronic PVT in a patient with JAK2 mutation leading to CTPV refractory to anticoagulation or endovascular intervention, eventually requiring MT. Though JAK2 is associated with myeloproliferative disorders, it is an independent risk factor for the development of PVT. With worsening thrombus chronicity and burden, cavernous transformation may occur which decreases the chance of successful TIPS. When organ ischemia develops due to extensive portomesenteric venous thrombosis, orthotopic liver transplantation is no longer an option. Multivisceral transplantation replaces the liver, small bowel, and other abdominal organs. Replacement of the thrombosed portomesenteric system may be the only recourse to reverse portal hypertension and address the primary disease.Figure 1.: Computed tomography angiography of hematoma in liver segments VII and VIII, demarcated by green lines. A complication from attempted portal vein access.

PORTAL VEIN THROMBOSIS IN PREGNANCY IN A PATIENT WHO HAD MILD INFECTION WITH COVID 19 VIRUS

Portal vein thrombosis (PVT) is rare in pregnancy . The most common underlying causes are abdominal trauma, pancreatitis, myeloproliferative disorders, and hereditary deciency of natural 2,3,4 anticoagulants (protein C, S and anti-thrombin III) . We report a case of acute PVT in a pregnant woman with no history of thrombosis or evidence of coagulation disorder or thrombophilia who had infection with SARS-CoV-2 (COVID 19).

A Case of Portal Vein Thrombosis Induced by Congenital Protein C Deficiency

A Case of Portal Vein Thrombosis Induced by Congenital Protein C Deficiency

A Case of Portal Vein Thrombosis after Laparoscopic Colectomy for Sigmoid Colon Cancer

A Case of Portal Vein Thrombosis after Laparoscopic Colectomy for Sigmoid Colon Cancer

Microvascular Flow Imaging in a Case of Portal Vein Thrombosis

Portal vein thrombosis (PVT) is a common complication of liver cirrhosis and is often the first sign of undetected hepatocellular carcinoma. It is crucial to differentiate malignant from benign thrombosis in determining prognosis and treatment. We describe a case of malignant PVT, detected for the first time by a new ultrasound technology, microvascular flow imaging, which can depict low flow in small vessels.

A Case of Portal Vein Thrombosis After Hepatic Injury for Which Edoxaban Was Effective

A Case of Portal Vein Thrombosis After Hepatic Injury for Which Edoxaban Was Effective

A Case of Portal Vein Thrombosis due to Protein S Deficiency which Avoided Intestinal Resection

A Case of Portal Vein Thrombosis due to Protein S Deficiency which Avoided Intestinal Resection

A case of portal vein thrombosis in a patient on clozapine

Portal vein thrombosis (PVT) is a rare but serious complication that can occur with the use of clozapine, an antipsychotic medication. PVT is characterized by the formation of a blood clot in the portal vein, which is responsible for carrying blood from the gastrointestinal tract to the liver. Clozapine use has been associated with an increased risk of PVT due to its effect on platelet function and the coagulation system. Patients on clozapine treatment who experience symptoms such as abdominal pain, nausea, and vomiting should seek immediate medical attention to rule out the possibility of PVT. We present the case of a 36-year-old man with PVT secondary to clozapine use.

SAT-660 Rare Case of Portal Vein Thrombosis Secondary to Acute Pyelonephritis in Type 1 Diabetic Patient

Background: Portal vein thrombosis (PVT) refers to venous thrombosis that develops within the extrahepatic portal venous system and can extend to the branches of the intrahepatic portal vein or up to splenic veins and superior mesenteric. A few cases have been reported about portal vein thrombosis in non-cirrhotic patient. Asymptomatic or non-specific symptom of portal vein thrombosis may lead to misdiagnosed or delay the diagnosis until the complications develop. We report a case of Portal vein thrombosis in type one diabetes associated with acute pyelonephritis. Case report: 18 years old female with type one diabetes on insulin pump present with epigastric abdominal pain for three days associated with nausea and vomiting of three days duration. On examination; conscious alert oriented young female looks in pain, vital sign were stable temperature 37oC, heart rate 89 beat per minute, blood pressure 103/72 mmHg, respiratory rate 20 per minute, oxygen saturation 100% and random blood sugar (RBS) 179 mg/dl. Abdominal examination revealed soft and lax abdomen with tenderness in the epigastric area and right renal angle. No sign of rigidity or rebound tenderness. Bowel sound was present. No sign of ascites, splenomegaly or hepatomegaly. Investigations showed; WBC: 10.2, neutrophil 65%, urine analysis WBCs 30-50 per high field microscopy, RBC 5-10, PH 7, negative nitrate and culture did not show any growth. ESR was 48 and CRP was 4.2. Thrombophilic screen was done and all within normal. Computed tomography (CT) reveled reduced enhancement of right kidney likely indicating acute pyelonephritis and portal vein edema with complete occlusion of left branch of portal vein. Local factors and prothrombotic disorders were ruled out. The patient was managed with ciprofloxacin, enoxaparin and warfarin. The patient was symptomatic free and discharge home with a therapeutic range INR. Conclusion: Portal vein thrombosis is uncommon condition in absence of liver diseases. Few case report liking between sepsis and portal vein thrombosis. Sepsis can create a predisposed environment for hypercoagulability.

Portal Vein Thrombosis in a Patient with Type 1 Diabetes Presenting as Acute Pyelonephritis.

BackgroundFew cases have been reported with respect to portal vein thrombosis in non-cirrhotic patients. Asymptomatic or non-specific symptoms of portal vein thrombosis may lead to misdiagnosis or may delay the diagnosis until complications develop. We report a case of portal vein thrombosis in a patient with type 1 diabetes presenting as acute pyelonephritis.Case descriptionAn 18-year-old female with type 1 diabetes on an insulin pump presented with epigastric abdominal pain for 3 days associated with nausea and vomiting. She was a conscious, alert, young female who appeared to be in pain. Vital signs were stable with a random blood sugar (RBS) level of 179 mg/dl. Abdominal examination revealed a soft and lax abdomen with tenderness in the epigastric area and right renal angle, as well as no sign of rigidity or rebound tenderness. No signs of ascites, splenomegaly or hepatomegaly were noted. Investigations showed a WBC count of 10.2, neutrophils at 65%, urine microsopy analysis revealed WBCs between 30–50 per high power field, with culture showing >105 CFU/ml. All parameters of a thrombophilic screen were within normal values. Computed tomography (CT) revealed reduced enhancement of the right kidney, likely indicating acute pyelonephritis, and left portal vein oedema with complete occlusion. Local factors and prothrombotic disorders were ruled out. The patient was managed with ciprofloxacin, enoxaparin and warfarin. Follow-up imaging revealed complete resolution of thrombosis.ConclusionsPortal vein thrombosis is an uncommon condition in the absence of liver disease. Few case reports exhibit sepsis and portal vein thrombosis. Sepsis can create a predisposed environment for hypercoagulability. To our knowledge, this is the first case report of pyelonephritis with portal vein thrombosis.LEARNING POINTSUntil now, no cases have linked acute pyelonephritis to portal vein thrombosis.Suspect the presence of portal vein thrombosis in a diabetic patient presenting with unusual abdominal pain.Complete revascularization occurs with early treatment.

Clinical case of chronic portal vein thrombosis

Portal vein thrombosis (PVT) is a form of venous thrombosis that causes impaired or terminated blood flow in the portal vein. PVT is the main reason for the development of extrahepatic portal hypertension. The article presents a clinical case of chronic PVT with signs of severe portal hypertension and ascites. A feature of the case is that in a patient with suspected decompensated cirrhosis of the liver with the ineffectiveness of standard treatment, PVT was detected. The cause of PVT was mechanical trauma of the portal vein and hemocoagulation thrombophilia. For health reasons, the patient was prescribed rivaroxaban. Rivaroxaban is an oral anticoagulant from the group of Xa inhibitors. Against the background of treatment, recanalization of PVT was noted in the patient. Our experiment has shown that rivaroxaban is a promising drug for treatment of PVT.

1519 Portal Vein Thrombosis as an Initial Presentation of Crohn's Disease

INTRODUCTION: Inflammatory bowel diseases (IBD) are chronic and progressive conditions that can increase the risk of thromboembolism, including portal vein thrombosis (PVT). PVT are exclusively described in cases with confirmed IBD diagnosis and are more commonly related to ulcerative colitis. This report highlights a case of PVT as an initial manifestation of Crohn's disease. CASE DESCRIPTION/METHODS: A 38-year-old gentleman presented with worsening abdominal pain, watery diarrhea and weight loss of the last three months. His initial diagnosis was diverticulitis and a course of oral ciprofloxacin was prescribed. As symptoms persisted, a colonoscopy was performed and showed diverticulitis in the descending colon. The pathology demonstrated acute cryptitis from rectum to cecum. Due to ongoing symptoms, a computed tomography (CT) of the abdomen without contrast was obtained and showed wall thickening and inflammatory changes in the small bowel. Despite another course of antibiotics with the addition of oral steroids, his pain worsened and thus repeat imaging was performed as an abdominal CT with contrast. He was found to have a chronic PVT extending into the superior mesenteric vein (SMV) and was transferred to our institution for further management. Physical exam was notable for mild tenderness in upper abdominal quadrants. Laboratory studies revealed mildly elevated CRP and ESR but his liver function was normal. Hematologic workups including hypercoagulability and clonal disorders were noncontributory. He endorsed a history of tobacco abuse, but no history of abdominal surgery nor family history of IBD. A CT enterography showed skip lesions suggestive of Crohn's enteritis along with thrombus in the right main portal vein and SMV. The pathology report from a repeat colonoscopy showed chronic active colitis. The patient then improved with high dose oral steroids and he was discharged on a tapered steroid regimen with oral anticoagulation. Follow-up appointments were scheduled with hematology and gastroenterology. DISCUSSION: In summary, this case represents one of the handful reported cases of PVT being the initial presentation of Crohn's disease. In those with an established IBD diagnosis, PVT should be considered with persistent abdominal pain in the absence of active inflammation. Early recognition of portal vein thrombosis may expedite treatment and prevent the consequences of portal hypertension.

1515 Portal Vein Thrombosis After Laparoscopic Sigmoid Colon Resection for Recurrent Diverticulitis

INTRODUCTION: Portal vein thrombosis (PVT) following laparoscopic surgery is a rare complication. PVT after laparoscopic colorectal surgery is usually associated with inflammatory conditions like IBD and is more likely to occur after total proctocolectomy and in presence of postoperative intra-abdominal infection. We report a case of PVT in a patient with no identifiable hypercoagulable disorder who underwent laparoscopic sigmoid colectomy for recurrent diverticulitis. CASE DESCRIPTION/METHODS: A 54 year old male with a past medical history of gout and no known history of thrombosis had recurrent diverticulitis. He also had Clostridium difficile infection secondary to antibiotic use. CT showed diverticulosis, but no portal vein thrombosis. He underwent robotic sigmoid colon resection with an uneventful postoperative course. Six months later he started noticing right upper quadrant abdomen pain and diarrhea that went on for five weeks. He denied confusion, ascites and GI bleed. His PCP ordered a CT abdomen in that showed right hepatic lobe atrophy and non-opacification of branches of right portal vein consistent with prior intrahepatic portal vein thrombosis. Lab work revealed normal CBC, negative stool studies, slightly elevated alkaline phosphatase of 137, AST of 31, ALT of 28, total bilirubin of 1. He was referred to our hepatology clinic. We repeated MR abdomen with and without contrast that confirmed chronic non-occlusive thrombus in the right portal vein, left portal vein and main portal vein were widely patent. Further lab work by hematology showed no evidence of thrombophilic condition. Repeat labs after three months showed normal LFTS and intact liver function. DISCUSSION: PVT as a complication of laparoscopic surgery is uncommon. Local and systemic factors contribute to development of post-op PVT. Thrombosis related to CO2pneumoperitoneum may be caused by hemodynamic changes like decrease in superior mesenteric arterial and portal venous blood flow. Issues with PVT have been seen related to splenectomy, bariatric procedures, and right hemicolectomy. Pneumoperitoneum induced hemodynamic changes and local inflammation due to diverticulitis might have contributed to PVT in our case.

A Case of Portal Vein Thrombosis and Pulmonary Thromboembolism Associated with Liver Cirrhosis and Essential Thrombocythemia

A Case of Portal Vein Thrombosis and Pulmonary Thromboembolism Associated with Liver Cirrhosis and Essential Thrombocythemia