Pyogenic Portal Vein Thrombosis as a Reservoir of Persistent Septicemia after Cyanoacrylate Injection for Bleeding Gastric Varices

Extra-hepatic portal vein thrombosis (EHPVO) represents the obstruction of the portal vein outside the liver and is not related to chronic liver disease or neoplasia. In chronic EHPVO, collateral veins and portal hypertension develop, resulting in splenomegaly and variceal formation. Myeloproliferative neoplasms (MPN) are the most frequent acquired etiology of EHPVO. These conditions put pregnant women at increased risk of vascular complications, including venous thrombosis, occlusion of the placental circulation, and variceal bleeding. In this report, we present a 36-year-old pregnant woman with chronic, anticoagulated EHPVO secondary to latent MPN who developed severe intrauterine growth restriction and had cesarean section at 32+1 weeks for increased umbilical doppler resistance and breech presentation. The article will emphasize outcome and management of pregnancies complicated by chronic EHPVO, portal hypertension, and MPN.

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Myeloproliferative diseases as causative agents of portal and hepatic veins thrombosis

Acta chirurgica iugoslavica ◽

10.2298/aci0701083c ◽

2007 ◽

Vol 54 (1) ◽

pp. 83-89

Author(s):

Dj. Culafic ◽

P. Miljic ◽

M. Perisic ◽

S. Djuranovic ◽

D. Popovic ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Gastric Varices ◽

Hepatic Veins ◽

Budd Chiari Syndrome ◽

Vein Thrombosis ◽

First Case ◽

Myeloproliferative Diseases ◽

Causative Agents ◽

Chiari Syndrome

Thrombosis of portal and hepatic veins is one of the most severe complications and most important causes of death of patients with chronic myeloproliferative diseases. Based on results of the past studies, myeloproliferative diseases were the causes of hepatic veins thrombosis in 30% and portal vein thrombosis in 20% of patients. The study presented 4 patients with myeloproliferative diseases complicated by thrombosis of splanchnic veins, aiming at the illustration of issue complexity in diagnostics and therapy. Two patients with portal vein thrombosis and recurring hemorrhage from esophageal varicosity were described. The first case was planned for shunting, while another case sustained bleeding on what account his anticoagulant therapy was discontinued, but it caused mesenterial thrombosis resulting in lethal outcome. Another two patients had hepatic veins thrombosis. Due to frequent, life-threatening bleeding from the esophageal and gastric varices, a patient with chronic Budd-Chiari syndrome and lineal vein thrombosis underwent mesocaval shunting. An immediate postoperative period was manifested by multiple thrombosis and hemorrhages that ended in his death. A patient with the acute Budd-Chiari syndrome was administered myelosuppressants and anticoagulants on time so reperfusion was restored. In myeloproliferative diseases, thrombosis of portal and hepatic veins gives rise to excessive portal hypertension with profuse hemorrhage from the esophageal and gastric varicosity which is difficult to manage because of complex coagulation disorders.

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Treatment of gastric varices with partial splenic embolization in a patient with portal vein thrombosis and a myeloproliferative disorder

World Journal of Gastroenterology ◽

10.3748/wjg.v20.i39.14495 ◽

2014 ◽

Vol 20 (39) ◽

pp. 14495 ◽

Cited By ~ 3

Author(s):

Robert Gianotti

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Gastric Varices ◽

Myeloproliferative Disorder ◽

Partial Splenic Embolization ◽

Vein Thrombosis ◽

Splenic Embolization

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

BioMed Research International ◽

10.1155/2020/9583706 ◽

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.

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Measurement of Exhaled Nitric Oxide in Cirrhotic Patients with Esophageal and Gastric Varices

BioMed Research International ◽

10.1155/2019/9673162 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Xiaoquan Huang ◽

Souksavanh Thansamay ◽

Kaiqi Yang ◽

Tiancheng Luo ◽

Shiyao Chen

Keyword(s):

Nitric Oxide ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Gastric Varices ◽

Exhaled Nitric Oxide ◽

Decompensated Cirrhosis ◽

Vein Thrombosis ◽

Esophageal And Gastric Varices ◽

Red Color ◽

Cirrhotic Patients

Background and aims. This study aimed to detect exhaled nitric oxide (eNO) level in cirrhotic patients and explore the correlation between eNO levels and the severity of cirrhosis. Methods. Patients were enrolled to analyze the relationship of eNO with noncirrhosis, cirrhosis, and complications of decompensated cirrhosis. We explored the potential predictive values of eNO in different states of cirrhosis. Results. The eNO levels were significantly increased in cirrhotic patients compared with noncirrhotic patients (14 (10–18) vs 8 (6–13) ppb, P<0.001). The eNO level was increased in those with ascites (15 (14–22) vs 13 (10–18) ppb, P=0.026), with portal vein thrombosis (19.5 (11.75–22) vs 13.5 (10–17) ppb, P=0.032), or with the mucosal red-color sign of esophageal and gastric varices (EGV) (16.5 (10–21.75) vs 13 (10–14.75) ppb, P=0.041). Among cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement, the eNO level was significantly increased in the high-HVPG group (HVPG >12 mm Hg) compared with the low-HVPG group (6 mm Hg ≤ HVPG ≤ 12 mm Hg) (15 (11.75–19.25) vs 10 (8–14) ppb, P=0.011). Conclusions. The eNO level was increased in cirrhotic patients, especially in those complicated with ascites, portal vein thrombosis, mucosal red-color sign of varices, and high HVPG.

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