scholarly journals Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

2019 ◽  
Vol 12 (4) ◽  
pp. e227271 ◽  
Author(s):  
Brittany Greene ◽  
Daniel Jones ◽  
Josée Sarrazin ◽  
Natalie G Coburn
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Gastric Perforation ◽  
Exploratory Laparotomy ◽  
Porta Hepatis ◽  
Surgical Exploration ◽  
Vein Thrombosis ◽  
History Of ◽  
Serial Ct ◽  
Upper Abdomen

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient’s upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient’s hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

scholarly journals A226 INCIDENTAL FINDING OF A LARGE GASTRIC VARIX ASSOCIATED WITH NEONATAL UMBILICAL VEIN CANALIZATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 261-263
Author(s):  
L Tsang ◽  
J Abraldes ◽  
E Wiebe ◽  
G S Sandha ◽  
S van Zanten
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Umbilical Vein ◽  
Gastroesophageal Junction ◽  
Splenic Vein ◽  
Gastric Varix ◽  
Vein Thrombosis ◽  
Inferior Aspect ◽  
Upper Abdomen

Abstract Results A 41-year old Asian male, who immigrated to Canada many years ago, and who had previously been successfully treated for Helicobacter pylori infection underwent gastroscopy for investigation of dyspepsia. His gastroscopy was normal except for a large subepithelial abnormality that was noted close to the gastroesophageal junction. Routine gastric biopsies from the antrum and body were normal. Subsequent endoscopic ultrasound revealed flow through the anechoic tortuous lesion and confirmed it was a very large isolated gastric varix type 1. Abdominal CT scan revealed chronic occlusion of the portal vein, splenic vein, and the portal confluence with extensive collateralization in the upper abdomen. There was complete cavernous transformation of the portal vein. Of the numerous varices in the upper abdomen, a very large varix drained into the left renal vein and indented into the posterior wall of the fundus of the stomach which accounted for the endoscopic finding. Multiple mesenteric veins were identified that connected to varices adjacent to the inferior aspect of the pancreas and duodenum. Notably, there was no evidence of cirrhosis or chronic pancreatitis. Liver enzymes, albumin, and INR were normal. Further collateral history revealed that he was hospitalized as a neonate for pneumonia with catheterization of the umbilical vein, which is known to be associated with thrombosis of the portal vein. Conclusions Detection of congenital absence of the portal vein (CAPV) is recognized more often due to advances in diagnostic imaging. Radiologically, the absence of the portal vein in CAPV is distinguished from portal vein thrombosis by the lack of venous collaterals or sequalae of portal hypertension, such as ascites or splenomegaly. A more gradual thrombosis of the portal vein may permit collaterals to develop without acute changes and is not equivalent to portal vein aplasia or agenesis as intrahepatic bile ducts are normal. The gold standard for diagnosis of CAPV is histologic absence of the portal vein in the liver on catheter angiography. CAPV is associated with abnormal embryologic development of the portal vein and frequently presents with complications of portal hypertension or portosystemic encephalopathy or the sequalae of venous shunts, hepatic or cardiac abnormalities found on imaging. Our case is an incidentally discovered absence of the portal venous system due to chronic thrombosis with extensive collateralization and an enlarged gastric varix protruding into the proximal stomach. It is well documented that canalization of the umbilical vein in infancy is associated with portal vein thrombosis, with incidences up to 68%. This case highlights the importance of eliciting a childhood hospitalization history in cases of non-cirrhotic portal hypertension. Funding Agencies None

Inherited thrombophilic abnormalities and risk of portal vein thrombosis

2008 ◽  
Vol 99 (04) ◽  
pp. 675-682 ◽  
Author(s):  
Matteo Galli ◽  
Monica Gianni ◽  
Walter Ageno ◽  
Francesco Dentali
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Western Europe ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Vein Thrombosis ◽  
Statistical Heterogeneity ◽  
Fixed And Random Effects ◽  
Study Characteristics ◽  
History Of

SummaryInherited thrombophilic abnormalities may have a role in the development of portal vein thrombosis (PVT).However, the prevalence of these factors in patients with PVT has been evaluated only in small studies with non-conclusive results. It was the purpose of this study to assess the risk of PVT associated with factorV Leiden (FVL) and G20210A prothrombin mutation (PTM). The MEDLINE, EMBASE, Cochrane Library databases, reference lists of retrieved articles and contact with content experts were used. Studies carried out in Western Europe comparing the prevalence of prothrombotic abnormalities in patients with PVT and in controls without a history of thromboembolic disease were included. Two reviewers independently selected studies and extracted study characteristics, quality and outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each trial and pooled using a fixed and random-effects model. Statistical heterogeneity was evaluated using the I2 statistic. Sensitivity analyses were performed examining separately studies according to the etiology of PVT and to control population. Twelve studies involving more than 3,000 patients were included. The pooled OR for PVT was 1.90 (95%CI: 1.25, 2.90) in patients with FVL and 4.48 (95%CI: 3.10, 6.48) in patients with PTM. In conclusion, PVT is associated with the presence of FVL and PTM in Western Europe.

Non tumoral portal vein thrombosis during cirrhosis: Should anticoagulation be proposed?

2018 ◽  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulant Therapy ◽  
Control Group ◽  
Case Group ◽  
Early Introduction ◽  
Vein Thrombosis ◽  
History Of ◽  
One Year ◽  
The Impact

Background: Portal vein thrombosis (PVT) is considered as infrequent and pejorative event in cirrhosis. Up to date, many questions remain about therapeutic management. Aim: The objectives of this study were to assess the impact of the PVT on the progression of liver disease, to review the indications for anticoagulation and its repercussions. Materials and methods: A case-control study was conducted over a period of 12 years (2002-2013). It included 484 cases of cirrhosis. Among these patients, 41 had non tumoral portal vein thrombosis (case group). The control group included the remaining 443 patients. Results: In our study, there was no impact of PVT on the natural history of cirrhosis both in terms of complications or survival. Only the early introduction of anticoagulant therapy was associated with a re-permeabilization of portal vein at one year (OR1.6; 95% CI [1.10-2.01]). Prolonged anticoagulation was inversely correlated with recurrent PVT after treatment. However, obtaining a portal vein re-permeabilization was not correlated to a significant gain in terms of prevention of complication related to cirrhosis and survival. Conclusions: results suggest that portal vein thrombosis in patients with cirrhosis is not a formal indication for anticoagulant therapy. It should be reserved for candidates of liver transplantation, those with an extension of the PVT to mesenteric vessels or with severe prothrombotic status. Key words: portal vein thrombosis, cirrhosis, anticoagulation.

scholarly journals Unhappy Triad: Infection with Leptospira spp. Escherichia coli and Bacteroides uniformis Associated with an Unusual Manifestation of Portal Vein Thrombosis

2021 ◽  
pp. 598-602
Author(s):  
Sven Kalbitz ◽  
Jörg Ermisch ◽  
Jonathan M. Schmidt ◽  
Ingo Wallstabe ◽  
Christoph Lübbert
Keyword(s):  
Escherichia Coli ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Intestinal Bacteria ◽  
Recurrent Fever ◽  
Coagulation Disorder ◽  
Vein Thrombosis ◽  
Atypical Manifestations ◽  
History Of

Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. We report on a 76-year-old German male who was admitted with a history of recurrent fever and acute renal failure. Blood cultures taken on admission showed <i>Escherichia coli</i>, as well as <i>Bacteroides uniformis</i> after an extended incubation period of 90 h. In addition, infection with <i>Leptospira</i> spp. was diagnosed serologically. Computerized tomography of the abdomen revealed an extensive PVT along with signs of colonic diverticulitis. Symptoms resolved under prolonged antimicrobial therapy with beta-lactams and adequate heparinization. A myeloproliferative disorder could be excluded. There was no evidence of an underlying coagulation disorder. Imaging controls showed an almost complete resolution of the PVT after 6 months of anticoagulation therapy. To the best of our knowledge, this is the first report of such an “unhappy triad,” which includes atypical manifestations of leptospirosis and involvement of other intestinal bacteria.

scholarly journals Portal Vein Thrombosis after the Consumption of Date Seed Powder: A Case Study

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mohammad Ali Zakeri ◽  
Mohammad Hossein Bagheripour ◽  
Marcello Iriti ◽  
Mahlagha Dehghan
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Nutritional Value ◽  
Functional Foods ◽  
Gastrointestinal Disease ◽  
Human Consumption ◽  
Vein Thrombosis ◽  
Oral Consumption ◽  
History Of

Date seeds can be used as ingredients to enhance the nutritional value of some functional foods for human consumption as well as additives in pharmaceutical and cosmetic industries. However, there are no reports on the complications of date seeds after oral consumption. We currently report a patient with no history of gastrointestinal disease, who has been admitted to the hospital with portal vein thrombosis (PVT) and suffered from complications.

scholarly journals Anticoagulant therapy in patients with liver cirrhosis and portal vein thrombosis: insights for the clinician

2018 ◽  
Vol 11 ◽  
pp. 175628481879356 ◽  
Author(s):  
Stefania Basili ◽  
Daniele Pastori ◽  
Valeria Raparelli ◽  
Francesco Violi
Keyword(s):  
Liver Cirrhosis ◽  
Natural History ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Vitamin K Antagonists ◽  
Current Evidence ◽  
Vein Thrombosis ◽  
Long Term Treatment ◽  
History Of ◽  
The Impact

Portal vein thrombosis (PVT) is a frequent complication in the natural history of patients with liver cirrhosis (LC). The prevalence of PVT in LC is highly variable, ranging from 0.6% to 25% according to different reports. The impact of PVT on the natural history of LC is unclear, but it seems to negatively affect the prognosis of patients undergoing liver transplantation (LT) by increasing post-LT mortality and delaying waiting time. The antithrombotic treatment of PVT is still challenging as PVT may often remain asymptomatic and incidentally diagnosed, and a spontaneous partial/total regression of PVT is observed in an important proportion of patients, even in the absence of anticoagulation. Recent evidence suggested that the anticoagulant treatment for PVT may favorably affect both ischemic and bleeding outcomes in LC patients. Anticoagulant therapies so far available include unfractioned heparin, low molecular weight heparins (LMWHs) and fondaparinux for acute treatment, and LMWHs and vitamin K antagonists (VKAs) for long-term treatment. No robust data currently support the use of direct oral anticoagulants (DOACs) in patients with LC and PVT, as the safety and efficacy of DOACs in this setting is still unclear. This review summarizes current evidence for the evaluation and management of patients with LC and PVT.

scholarly journals Risk Factors of Portal Vein Thrombosis after Devascularization Treatment in Patients with Liver Cirrhosis: A Nested Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Shenxin Lu ◽  
Guohua Hu ◽  
Shiyao Chen ◽  
Jian Wang
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
White Blood Cell ◽  
Gastric Varices ◽  
Trunk Diameter ◽  
Vein Thrombosis ◽  
History Of

Background and Aim. To investigate the incidence of portal vein thrombosis (PVT) after devascularization treatment and to explore the risk factors of perioperative PVT and PVT diagnosed during the follow-up period after surgery. Methods. We retrospectively reviewed medical records from cirrhosis patients who underwent devascularization for the treatment of portal hypertension in our hospital between January 1, 2008, and December 20, 2014. Patients were followed up to investigate the PVT incidence at different times after surgery. Patients were divided into two groups (PVT, no PVT), and the risk factors for PVT after surgery were determined. Results. Until October 16, 2015, the median follow-up time of the 124 patients enrolled into this study was 41.43 months (range, 5.47–95.30 months). 61 patients had perioperative PVT, and 21 (16.94%) patients had PVT diagnosed during the follow-up period. Those who had lower preoperative white blood cell counts, larger preoperative portal vein trunk diameter, and no gastric varices were more likely to have perioperative thrombosis. In those without perioperative PVT, a history of hypertension, higher grade of splenomegaly, and higher preoperative levels of creatinine were independent predictors of PVT occurrence during the follow-up period. Conclusions. The risk factors for perioperative PVT in cirrhotic patients after devascularization were lower preoperative white blood cell count and larger portal vein trunk diameter, with no gastric varices. A history of hypertension, a larger spleen, and higher preoperative creatinine level are independent predictors of PVT during follow-up after surgery in patients without perioperative PVT.

New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

2020 ◽  
Vol 46 (06) ◽  
pp. 673-681 ◽  
Author(s):  
Oana Nicoară-Farcău ◽  
Guillem Soy ◽  
Marta Magaz ◽  
Anna Baiges ◽  
Fanny Turon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Current Knowledge ◽  
Current Evidence ◽  
Special Focus ◽  
Vein Thrombosis ◽  
Frequent Event ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of

AbstractPortal vein thrombosis (PVT) is a frequent event in patients with cirrhosis regardless of etiology. Notwithstanding the commonality of the problem, the pathophysiology and risk factors for PVT in cirrhosis are largely unknown. The clinical impact of PVT in the natural history of cirrhosis is unclear, indications for PVT treatment are not well defined, and treatment recommendations are based on experts' opinion and consensus only. Therefore, this review aims to summarize current knowledge of mechanisms and risk factors for PVT development and assess the current evidence of PVT management, with a special focus on strategies of anticoagulation and transjugular intrahepatic portosystemic shunt placement.

scholarly journals Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
F. Chegai ◽  
A. U. Cavallo ◽  
M. Forcina ◽  
V. Giuricin ◽  
F. Castellani ◽  
...  
Keyword(s):  
Portal Vein ◽  
Autoimmune Hepatitis ◽  
Portal Vein Thrombosis ◽  
Overlap Syndrome ◽  
Splenorenal Shunt ◽  
Maximum Diameter ◽  
Primary Biliary Cholangitis ◽  
Vein Thrombosis ◽  
History Of ◽  
The Impact

We present a case of giant Splenorenal Shunt (SRS) associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident. SRS was located among the spleen hilum and the left kidney with a maximum diameter of 3.25 cm and was associated with dilatation of left renal vein and inferior vena cava. After a multidisciplinary evaluation the patient was put on the Regional Liver Transplant waiting list and liver transplantation was performed successfully. Although portal vein thrombosis and SRS are common occurrences in cirrhotic patients, the impact in the natural history of the disease is still unclear. Careful management and accurate imaging protocols are essential in the evaluation of those patients.

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