A case of portal vein thrombosis associated with acute cholecystitis/pancreatitis or coincidence

BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervention. PVT is commonly forgotten as a possible cause of abdominal pain. The clinical picture may vary but abdominal pain and low grade fever are the most characteristic picture. METHODS: A 58-year-old male patient was admitted to our hospital complaining of abdominal pain for three days. CT scan revealed an edematous area around the portal vein. Doppler ultrasonography showed evidence of a portal vein thrombosis. RESULTS: PVT can be diagnosed with CT and Doppler ultrasonography. Fresh thrombus can be undetected by sonography because of the low echogenity but can be recognised by color Doppler ultrasonography. Treatment ranges from observation and bowel rest to surgical resection of bowel. CONCLUSIONS: When we suspect a case of PVT, it should be treated at an early stage to prevent being lost in a diagnostic dilemma. The immediate use of anticoagulant could be important in preventing serious consequences of PVT.     

A case of portal vein thrombosis complicating acute cholangitis treated successfully with danaparoid sodium

An 81-year-old woman was referred to our hospital with a diagnosis of acute cholangitis. Endoscopic retrograde cholangiography revealed a common bile duct (CBD) stone. In addition, CT showed thrombus of the right portal vein. Endoscopic sphincterotomy was performed to remove the CBD stone. Thrombosis was treated successfully with danaparoid sodium. It was speculated that the treatment of the acute cholangitis induced thrombolysis by the auto-fibrinolysis system and danaparoid sodium prevented the development of thrombus formation in this case.     

A case of portal vein thrombosis associated with congenital protein S deficiency]

A 25-year-old man was admitted to our hospital because of abdominal pain, nausea and low-grade fever. An abdominal CT showed remarkable thickening of the wall of the small intestine and extensive thrombosis of the mesenteric, portal and splenic veins. Because neither intestinal infarction nor peritonitis was seen, anticoagulation therapy was chosen. Heparin was administered intravenously and was used alternatively with warfarin later. The patient's symptoms and clinical data improved gradually. Concerning the etiological factors of the thrombosis, only protein S activity definitely decreased. Genetic analysis indicated a variant of protein S, protein S Tokushima.     

Incidence and factors associated with portal vein thrombosis in patients with acute pancreatitis: A United States national retrospective study

Background/ObjectivePortal vein thrombosis (PVT) is a well-known complication in patients with acute pancreatitis (AP). Limited data exist on the incidence and factors of PVT in patients with AP. We investigate the incidence and clinical predictors of PVT in AP.MethodsWe queried the 2016–2019 National Inpatient Sample database to identify patients with AP. Patients with chronic pancreatitis or pancreatic cancer were excluded. We studied demographics, comorbidities, complications, and interventions in these patients and stratified the results by the presence of PVT. A multivariate regression model was used to identify factors associated with PVT in patients with AP. We also assessed the mortality and resource utilization in patients with PVT and AP.ResultsOf the 1,386,389 adult patients admitted with AP, 11,135 (0.8%) patients had PVT. Women had a 15% lower risk of developing PVT (aOR-0.85, p < 0.001). There was no significant difference between the age groups in the risk of developing PVT. Hispanic patients had the lowest risk of PVT (aOR-0.74, p < 0.001). PVT was associated with pancreatic pseudocyst (aOR-4.15, p < 0.001), bacteremia (aOR-2.66, p < 0.001), sepsis (aOR-1.55, p < 0.001), shock (aOR-1.68, p < 0.001) and ileus (aOR-1.38, p < 0.001). A higher incidence of in-hospital mortality and ICU admissions was also noted in patients with PVT and AP.ConclusionThis study demonstrated a significant association between PVT and factors such as pancreatic pseudocyst, bacteremia, and ileus in patients with AP.     

Left branch portal vein thrombosis associated with hyperhomocysteinemia

A 34 year-old man, who was a smoker, was hospitalised because of severe epigastric and right upper quadrant pain. An isolated left branch portal vein thrombosis was diagnosed using ultrasonography and arteriography. Two thrombogenic pathologies were found: i) a latent myeloproliferative syndrome with spontaneous presence of erythroid colony forming unit (CFU-E) in bone marrow culture, normal blood cell count, platelet count and medullogram; ii) a hyperhomocysteinemia associated with low serum folate levels and a methyl tetrahydrofolate reductase mutation. The association of these two factors probably resulted in portal vein thrombosis. This is the first adult case of a portal vein thrombosis associated with hyperhomocysteinemia. Increased homocysteine serum levels could be a previously unrecognized factor for portal vein thrombosis. Homocysteinemia should be systematically investigated in patients with idiopathic portal vein thrombosis since folate supplements could prevent deleterious vascular effects of hyperhomocysteinemia.     

急性胰腺炎并发门静脉系统血栓152例临床特点和临床预测

目的:探讨急性胰腺炎(AP)伴发门静脉系统血栓(PVST)的临床特点和症状性PVST的临床预测。方法:回顾性分析2014年1月至2019年12月昆明医科大学第一附属医院和第二附属医院符合AP并发PVST诊断标准并有完整临床资料的住院患者152例,对其临床特点进行分析。按照是否发生PVST所致临床表现(食管-胃底静脉曲张...     

A case of pancreaticoportal fistula associated with acute severe pancreatitis]

Pancreatic fistulas are usually caused by the disruption of pancreatic duct. The majority of pancreatic fistulas are external fistulas and common causes of external and internal pancreatic fistulas are trauma and surgery. Internal pancreatic fistulas due to pancreatitis are rare. Internal pancreatic fistulas may communicate with peritoneal cavity, colon, small bowel, biliary system or pleural cavity. Among them, fistula between pancreatic duct and portal vein due to acute pancreatitis is rare. We report a case of 32-year-old male with fistula between pancreatic duct and portal vein as a complication of acute pancreatitis. Pancreaticoportal fistula was diagnosed by endoscopic retrograde cholangiopancreatography. He recovered after distal pancreatectomy with splenectomy and supportive care.     

Splenic vein thrombosis in patients with acute pancreatitis

We performed a retrospective autopsy case-control study to identify clinical characteristics of acute pancreatitis associated with splenic vein thrombosis. Age, sex, spleen weight, presence or absence of gastrointestinal hemorrhage, and pancreatic pseudocyst were not associated with splenic vein thrombosis. Patients with peak serum amylase over 10,000 U/L were at high risk for splenic vein thrombosis. We conclude that, of the factors examined, only the peak serum amylase may be of value in diagnosing splenic vein thrombosis in patients with acute pancreatitis.     

Splenic vein thrombosis in patients with acute pancreatitis

We performed a retrospective autopsy case-control study to identify clinical characteristics of acute pancreatitis associated with splenic vein thrombosis. Age, sex, spleen weight, presence or absence of gastrointestinal hemorrhage, and pancreatic pseudocyst were not associated with splenic vein thrombosis. Patients with peak serum amylase over 10,000 U/L were at high risk for splenic vein thrombosis. We conclude that, of the factors examined, only the peak serum amylase may be of value in diagnosing splenic vein thrombosis in patients with acute pancreatitis.     

A case of portal vein thrombosis in patient with ulcerative colitis

Portal vein thrombosis is a rare and serious complication in ulcerative colitis (UC). We report a patient with UC who developed portal vein thrombosis with persistent ascites which was successfully managed with total colectomy. A 46-year-old man was admitted complaining of bloody stool. UC had been diagnosed 11 years previously. He required subtotal colectomy because his colitis did not respond to conservative therapy and worsened with suspected peritonitis. Although the portal vein thrombosis was diagnosed after surgery and the systemic anti-coagulant therapy was started, this was stopped after 2 days because of massive rectal bleeding. Fortunately, sufficient hydration with intravenous infusion and re-infusion of concentrated ascites led to portal vein thrombolysis successfully after 28 postoperative days. This case suggests that colectomy and sufficient hydration may have a favorable effect on treatment of portal vein thrombosis in patients with UC.     

肝硬化急性门静脉血栓自发性再通1例报告

<正>门静脉血栓(PVT)是肝硬化常见的并发症之一,若合并严重的腹腔感染,则出现PVT的机率会更高,Wang等[1]研究就表明腹腔感染与PVT有关。本文报道1例肝硬化突发消化道出血合并腹腔感染导致急性PVT后,出现自发性再通的诊疗经过,提醒临床医生,对于病情危重的肝硬化PVT患者若无法行药物溶栓或手术治疗,积极治疗原发病和去除诱发因素也至关重要,同样可能取得良好的治疗效果。现将该病例诊疗经过     

A case of systemic lupus erythematosus associated with severe acute pancreatitis]

A 22-year-old woman began to have the symptoms of anorexia, high fever, cough and general fatigue from June of 1997. She was admitted in our hospital on Aug. 8th, 1997 for the further detail examination because of pancytopenia and positive antinuclear antibody (ANA). Her laboratory findings and clinical symptoms were compatible with systemic lupus erythematosus (SLE) such as leukopenia, proteinuria, hypocomplementemia, positive ANA, elevated titer of autoantibodies including anti-DNA, anti-Sm, anti-RNP antibodies, polyarthralgia and photosensitivity. The administration of oral prednisolone (40 mg/day) was started on Aug. 15th, 1997 under the diagnosis of SLE. However, she had severe abdominal pain in epigastrium with elevated serum amylase, ascites and dull shape of pancreas tail by CT scan compatible with acute pancreatitis. On Aug. 18th, her general condition was worsening with fever, epigastralgia, abdominal distension, anemia, weak palpation of radial artery, hypotension, tachycardia, shallow breathing and cold sensation on both extremities as shock. In spite of steroid pulse therapy with nafamostat mesilate intraarterial infusion, her condition was not improved. The dose of 50 mg/day of cyclophosphamide was added to the regimen on Aug. 22nd. Then, gradually her condition started to be restored. Anemia, leukopenia, hypocomplementemia continued. Second steroid pulse therapy was done on Sep. 5th. After then, she became better in her clinical symptoms and laboratory data. The dose of PSL was tapered to 15 mg/day and 7.5 mg/day update of Oct. 1998 without the pseudcysts found after pancreatitis. She is a rare case who recovered from severe acute pancreatitis due to SLE itself.     

A case of antiphospholipid syndrome associated with left subclavian artery thrombosis and left external iliac vein thrombosis]

Arterial thrombosis is one of the major symptoms of antiphospholipid syndrome (APS). However, thrombosis in a primary branch of the aorta has rarely been reported in APS. We report here a case of APS complicated by thromboses in both the left subclavian artery and the left external iliac vein. A 32-year-old woman was admitted in May, 1990 complaining of no pulse in the left superficial arteries (e.g., left radial artery) for the past 5 years and acute swelling of the left lower extremity. A left ascending phlebography showed an occlusion of the external iliac vein and arteriography revealed obstruction in the left subclavian artery. Collateral circulations were developed at the site of each thrombus. Clotting and immunological studies revealed a prolonged APTT, a high titer of anticardiolipin antibody and lupus anticoagulant positive. We ruled out various diseases and clinical risk factors predisposing to both arterial and venous thromboses. Accordingly, we concluded that both thromboses were based on APS. Following treatment with anticoagulants, aspirin and corticosteroid, the swelling of her left thigh was diminished and the antibody titer was decreased within 3 months.     

Primary antiphospholipid syndrome presented with portal vein thrombosis]

Antiphospholipid Antibody Syndrome (APS) is defined by arterial and venous thrombosis, recurrent spontaneous abortions and thrombocytopenia associated with persistence of antiphospholipid antibodies. Thrombosis may involve virtually all arterial or venous sites, but deep vein thrombosis of the lower limbs are the most common; however, unusual thrombi that involve the portal vein have been described. We report females with documented portal vein thrombosis and primary APS. The treatment of these patients is difficult because of the risk of bleeding and the recurrent thrombosis if they don't receive appropriate long-term anticoagulant therapy.     

Prothrombin G20210A gene variant is not associated with idiopathic portal vein thrombosis in an area endemic for portal vein thrombosis

Prothrombin G20210A gene variant has been found in 0–23% of patients with portal vein thrombosis (PVT). This wide variation makes it difficult to assess the importance of prothrombin G20210A gene variant as a predisposing factor for PVT. In this study from South India, none of the patients with idiopathic PVT (0/38) or any of the controls (0/46) had prothrombin G20210A gene variant. Prothrombin G20210A gene variant does not contribute to the development of PVT in India.