Portal vein thrombosis concomitant with thrombophilia during pregnancy

Pregnancy and vascular liver disease

Vascular disorders of the liver frequently affect women of childbearing age. Pregnancy and the postpartum are prothrombotic states. Pregnancy seems to be a trigger for Budd-Chiari syndrome in patients with an underlying prothrombotic disorder. Whether pregnancy is a risk factor for other vascular liver disorders is unknown. In women with a known vascular liver disorder and a desire for pregnancy, stabilisation of the liver disease, including the use of a portal decompressive procedure when indicated, should be reached prior to conception. The presence of esophageal varices should be screened and adequate prophylaxis of bleeding applied in a manner similar to what is recommended for patients with cirrhosis. Most women likely benefit from anticoagulation during pregnancy and the postpartum. Labor and delivery are best managed by a multidisciplinary team with experience in this situation. Assisted vaginal delivery is the preferred mode of delivery. Although the risk of miscarriage and premature birth is heightened, current management of these diseases makes it very likely to see the birth of a live baby when pregnancy reaches 20 weeks of gestation.

[Diagnosis of postpartum abdominal pain: about a rare case of portal vein thrombosis]

We report the management of patient with acute abdominal pain in the immediate post-partum caesarean section performed in the context of preeclampsia. Acute portal vein thrombosis is diagnosed, in a patient with no personal or family history of venous thrombosis. Blood tests showed a protein C and S deficiencies. Portal vein thrombosis is an extremely rare occurrence in pregnancy and postpartum.

Massive bleeding in pregnancy from ruptured oesophageal varices complicating portal hypertension: a cautionary tale

Portal vein thrombosis (PVT) is a rare complication of pancreatitis and can cause portal hypertension and oesophageal varices. Variceal rupture carries a high mortality. We report a case of successful pregnancy complicated by two episodes of massive variceal bleeding in a woman with PVT, and discuss how this might have been prevented.

Vascular disorders of the liver: recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee

This review summarizes the document elaborated by the Italian Association for the Study of the Liver (AISF) ad hoc committee "Vascular disorders of the liver" on the primary circulatory liver diseases, which include Budd-Chiari syndrome, obstruction of the hepatic portion of the inferior vena cava, portal vein thrombosis, sinusoidal obstruction syndrome (veno-occlusive disease) and hereditary hemorrhagic telangiectasia. A characteristic of the primary circulatory liver diseases is that portal hypertension usually precedes liver dysfunction. Significant overlap exists amongst the diseases and risk factors that predispose patients to the primary circulatory liver diseases, though the pathogenesis of individual diseases varies. Management of the different vascular disorders is very peculiar and often multidisciplinary and patients should be referred to a tertiary referral centre for optimal care.

[Atypical abdominal pain in the first trimester of pregnancy]

We report the case of a 22-year-old woman who presented a violent epigastric pain at eight-weeks gestation. Superior mesenteric vein thrombosis was detected, with an extension to portal vein and remaining blood flow. Screening for thrombophilia revealed a heterozygote prothrombin gene mutation. Portal vein thrombosis is uncommon and difficult to diagnose. Diagnosis is made by Doppler ultrasound, a second intention test to be done in case of unusual upper abdominal pain during pregnancy.

Thalassemia intermedia and cavernous transformation of portal vein thrombosis in pregnancy

We report a rare case of a cavernous transformation of portal vein (CTPV) thrombosis accompanied by Thalassemia and thrombophilia during pregnancy that was successfully treated by low molecular weight heparin. The clinical presentation, diagnosis and the treatment are discussed.

Portal vein thrombosis associated to prothrombin G20210A mutation and protein C deficiency

We describe a patient with left branch portal vein thrombosis involving two thrombophilic alterations, the prothrombin G20210A mutation and protein C deficiency. In spite of not being under anticoagulant treatment, the thrombus in the portal vein underwent complete and spontaneous lysis. No other risk factors were detected and no family history related to thrombosis was found.