Extrahepatic portal vein thrombosis in a pregnant patient with COVID-19: a rare thrombotic event survivor

A COVID-19 infection predisposes the infected person to thrombotic events. Myocardial infarction, acute limb ischaemia, mesenteric artery thrombosis and pulmonary embolism are all well-documented complications of this infection. Here we describe a pregnant patient who presented with obstructed labour with asymptomatic COVID-19 infection and developed ascites during the postoperative period. Further work-up of the patient revealed portal hypertension due to portal vein thrombosis (PVT). As the patient was healthy before this index pregnancy, a causative link between COVID-19 and PVT cannot be ruled out. Her COVID-19 infection progressed to a moderate disease. She was managed with steroids and appropriate antibiotics for secondary bacterial peritonitis. She was finally discharged after 2.5 months of multidisciplinary treatment. This is a case of a survivor of complications due to pregnancy, COVID-19 and extrahepatic portal vein obstruction.

Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.