Portal Vein Thrombosis following Total Colectomy due to Colonic Inertia: A Case Report and Evaluation of Risk Factors

The portal vein could be occluded by blood clots partially or completely causing portal vein thrombosis (PVT). The acute episode may be asymptomatic or manifested by abdominal pain, increasing body temperature, and unspecific dyspeptic symptoms. The main causes of PVT are categorized into local, acquired, and genetic thrombophilic factors. To our knowledge, this is the 2nd recognized case of PVT following colectomy for colonic inertia successfully treated with an effective anticoagulation therapy. The patient received unfractionated heparin as soon the diagnosis was implemented. The patient was a 34-year-old lady with chief complaint of severe abdominal pain, nausea, vomiting, and anorexia 10 days after the first hospital admission for subtotal colectomy due to colonic inertia. Spiral abdominal CT scan with intravenous (IV) contrast showed thrombosis in main portal vein with its extension to right and left intrahepatic branches. Our case showed that we should keep in mind PVT in patients who present with upper gastrointestinal symptoms several days after a major surgery (open colectomy) as a risk factor and oral contraceptive pills (OCP) usage, postpregnancy, and immobility as other risk factors, that the protein C, S, and FVL deficiencies were secondary, and that the PVT can be managed by low molecular weight heparin plus oral warfarin therapy in the continue.

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Acute portal vein thrombosis secondary to COVID-19: a case report

BMC Gastroenterology ◽

10.1186/s12876-020-01518-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Roham Borazjani ◽

Seyed Reza Seraj ◽

Mohammad Javad Fallahi ◽

Zhila Rahmanian

Keyword(s):

Abdominal Pain ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Acute Abdominal Pain ◽

Anticoagulation Therapy ◽

Pulmonary Complications ◽

Case Presentation ◽

Vein Thrombosis ◽

Extra Pulmonary ◽

Secondary Causes

Abstract Background COVID-19 pneumonia exhibits several extra-pulmonary complications. Case presentation A 23-year old, asthmatic male with coronavirus pneumonia developed with generalized, acute abdominal pain. Further evaluations revealed a mild ascites and portal vein thrombosis although the patient received proper anticoagulation therapy. Routine lab data regarding the secondary causes of portal vein thrombosis were normal. Conclusion We speculated that the underlying cause of portal vein thrombosis in our case was coronaviruses. Therefore, clinicians should always consider thrombosis and other hypercoagulable diseases in patients with COVID-19.

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Portal Venous Thrombosis in a Special Operations Paratrooper: A Case Report

Military Medicine ◽

10.1093/milmed/usab387 ◽

2021 ◽

Author(s):

Rachel E Bridwell ◽

Sean Clerkin ◽

Nathaniel R Walker ◽

Brit Long ◽

Sarah Goss

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal System ◽

Thrombotic Occlusion ◽

Special Operations ◽

Vein Thrombosis ◽

Portal Venous Thrombosis ◽

Abdominal Infections

ABSTRACT Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population.

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Cytomegalovirus (CMV)-associated portal vein thrombosis in a healthy, immunocompetent man

BMJ Case Reports ◽

10.1136/bcr-2020-238645 ◽

2020 ◽

Vol 13 (12) ◽

pp. e238645

Author(s):

Caroline Burkey ◽

Catherine Teng ◽

Khalil Ian Hussein ◽

James Sabetta

Keyword(s):

Abdominal Pain ◽

Literature Review ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulation Therapy ◽

Abdominal Ct ◽

Vein Thrombosis ◽

Abdominal Ct Scan ◽

Specific Symptoms ◽

Acute Cytomegalovirus

We present a previously healthy man in his 30s who presented with typical viral prodrome symptoms and worsening abdominal pain. He was found to have portal vein thrombosis, with extensive hypercoagulability workup performed. It was determined that the aetiology of thrombus was secondary to acute cytomegalovirus infection. The patient was started on anticoagulation therapy, with later clot resolution demonstrated on abdominal Doppler ultrasound and abdominal CT scan. Given the atypical presentation of this common virus, we performed a literature review of cytomegalovirus-associated portal vein thrombosis in healthy individuals; we found that most patients present with non-specific symptoms of fever and abdominal pain in the setting of a viral prodrome. This case and literature review suggest physicians must consider cytomegalovirus-associated portal vein thrombosis as a potential diagnosis when patients present with abdominal pain and viral symptoms. The literature highlights the need for a consensus on anticoagulation and antiviral therapy.

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Portal vein thrombosis in patients with liver cirrhosis: Risk factors and clinical presentation

10.21203/rs.3.rs-817130/v1 ◽

2021 ◽

Author(s):

Sondes Bizid ◽

Houssaina Jlassi ◽

Maroua Ben Abbes ◽

Ghanem Mohamed ◽

Hela Ghedira ◽

...

Keyword(s):

Risk Factors ◽

Liver Cirrhosis ◽

Liver Disease ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulation Therapy ◽

Factor V Leiden ◽

Factor V Leiden Mutation ◽

Vein Thrombosis ◽

Increased Risk

Abstract Background:Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. PVT impact on disease progression is not clarified as yet. Anticoagulation therapy is considered effective in this setting, but is associated with potentially bleeding episodes. Aim : to assess the risk factors and clinical impact of non-neoplastic PVT complicating cirrhosis, as well as the treatment profile and its efficacy in clinical practice.Methods:A retrospective monocentric study over a period of 19 years including all patients diagnosed with cirrhosis and non-neoplastic PVT was conducted.Results:A total of 49 patients were enrolled in the present study.The mean age was 60.86±11.61 years old. Chronic viral hepatitis was the most frequent cause of cirrhosis (63.2%). Most of our cases had advanced liver disease (89.9% Child class B/C) with a mean MELD score of 19.27. The risk factors for thrombophilia, inherited or acquired, were: a deficiency in coagulation inhibitors, either isolated or combined (protein S, protein C and antithrombin III) in 19 patients, a heterozygous Factor V Leiden mutation in 2 patients, a heterozygous MTHFR mutation in one patient, an antiphospholipid antibodies syndrome in 2 patients, an essential thrombocythemia in one patient. Anticoagulant therapy was indicated in half of the cases. Multivariate analyses demonstrated that thrombus extension was the only independent predictive factor of portal vein recanalization (p=0.009). During follow-up, progression was observed in 8% of treated patients with anticoagulants versus 12.5% of untreated patients (p=0.12). Our study has shown that anticoagulant treatment is not associated with elevated risk of bleeding or developing other complications. The mean survival was higher in patients treated successfully (38.31 months Vs 23.41 months, p=0.204). Conclusions:Our outcomes confirm that anticoagulation therapy in cirrhotic patients with non-neoplastic PVT is not associated with increased risk of liver disease decompensation, including bleeding.

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Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis

Case Reports in Vascular Medicine ◽

10.1155/2021/8832638 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Venkata Ram Pradeep Rokkam ◽

Gurusaravanan Kutti Sridharan ◽

Rathnamitreyee Vegunta ◽

Radhakrishna Vegunta ◽

Umesha Boregowda ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Abdominal Pain ◽

Clostridium Difficile ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Clostridium Difficile Infection ◽

Thrombotic Risk ◽

Vein Thrombosis ◽

Venous Thromboembolic Events

The COVID-19 pandemic has created an unprecedented global health care crisis. COVID-19 patients are found to have increased thrombotic risk. Despite being on prophylactic anticoagulation, many develop serious arterial and venous thromboembolic events. Emerging reports indicate COVID-19 may be considered a novel risk factor for portal vein thrombosis. Although, intra-abdominal infections are identified as risk factors, clostridium difficile colitis has not been typically seen as a risk factor for PVT. We report a case of an elderly female with a recent diagnosis of COVID-19 and no prior history of cirrhosis or malignancy who presented with diarrhea due to clostridium difficile infection. She developed sudden onset severe abdominal pain during the course of hospitalization. Acute portal vein thrombosis was identified on CT imaging of the abdomen, and she improved well with therapeutic anticoagulation. Acute portal vein thrombosis usually results from a combination of local and systemic prothrombotic risk factors. The combination of local infection by clostridium difficile and COVID-19 coagulopathy led to development of portal vein thrombosis in our patient. To the best of our knowledge, this is the first case of portal vein thrombosis reported in a patient with clostridium difficile infection in the setting of COVID-19 coagulopathy. During the current pandemic, clinicians should strongly consider abdominal imaging in patients presenting with abdominal pain due to clostridium difficile infection in the setting of COVID-19 to rule out complications such as portal vein thrombosis. Early diagnosis and treatment of portal vein thrombosis prevent complications of portal hypertension and intestinal infarctions.

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Cerebellar hemorrhage in patients treated with edoxaban for portal vein thrombosis after hepatobiliary surgery: a report of two cases

Surgical Case Reports ◽

10.1186/s40792-020-01086-3 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroya Iida ◽

Toru Miyake ◽

Masaji Tani ◽

Takuya Tanaka ◽

Kayo Kawakami ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Anticoagulation Therapy ◽

Anterior Segment ◽

Left Lobe ◽

Ventricular Drainage ◽

Hepatobiliary Surgery ◽

Cerebellar Hemorrhage ◽

Hematoma Evacuation ◽

Vein Thrombosis

Abstract Background The standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years. Case presentation Case 1 A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection. Case 2 A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery. Conclusions Although edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.

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