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Cazacu SM, Alexandru DO, Dumitrescu D, Vieru AM, Urhuț MC, Săndulescu LD. Prevalence and Risk Factors for Portal Cavernoma in Adult Patients with Portal Vein Thrombosis. Diagnostics (Basel) 2024; 14:1445. [PMID: 39001335 PMCID: PMC11241764 DOI: 10.3390/diagnostics14131445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Portal vein thrombosis (PVT) represents a restriction or occlusion of the portal vein by a blood clot, which can appear in liver cirrhosis, inherited or acquired thrombophilia, malignancies, abdominal infection, abdominal inflammation, and injury to the portal vein; it can evolve to local venous extension, recanalization, or portal cavernoma (PC). This research represents an observational study of patients admitted with a diagnosis of PVT between January 2018 and December 2022. We assessed the rate of and risk factors for PC. In total, 189 patients with PVT were included; the rate of PC was 14.8%. In univariate and multivariate analysis, the main risk factors for the presence of PC were etiology (thrombophilia, myeloproliferative disorders, local inflammatory diseases, and idiopathic causes), prior PVT, and complete versus incomplete or single-branch portal obstruction. In patients with superior mesenteric vein (SMV) thrombosis, distal obstruction was more prone to PC than proximal obstruction. The main predictive factors were etiology, prior PVT, complete PVT obstruction, and no prior non-selective beta-blocker (NSBB) use; in patients with SMV thrombosis, the distal extension was more significantly associated with the risk of PC. We propose a composite score for the prediction of PC which includes etiology, prior diagnosis of PVT, prior NSBB use, complete versus incomplete PVT, and distal versus proximal SMV thrombosis, with good accuracy (AUC 0.822) and an estimated sensitivity of 76.92% and specificity of 82.39% at a cut-off value of 4.
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Affiliation(s)
- Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349, Craiova, Romania; (S.M.C.); (L.D.S.)
| | - Dragoș Ovidiu Alexandru
- Biostatistics Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349 Craiova, Romania;
| | - Daniela Dumitrescu
- Imaging Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349 Craiova, Romania;
| | - Alexandru Marian Vieru
- Doctoral School, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349 Craiova, Romania;
| | - Marinela Cristiana Urhuț
- Doctoral School, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349 Craiova, Romania;
| | - Larisa Daniela Săndulescu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Petru Rares Street no. 2-4, 200349, Craiova, Romania; (S.M.C.); (L.D.S.)
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Gomes R, Costa-Pinho A, Ramalho-Vasconcelos F, Sousa-Pinto B, Santos-Sousa H, Resende F, Preto J, Lima-da-Costa E. Portomesenteric Venous Thrombosis after Bariatric Surgery: A Case Series and Systematic Review Comparing LSG and LRYGB. J Pers Med 2024; 14:722. [PMID: 39063976 PMCID: PMC11277930 DOI: 10.3390/jpm14070722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Portomesenteric Venous Thrombosis (PMVT) is a rare but serious complication of Metabolic Bariatric Surgery (MBS). Although more frequently reported after laparoscopic sleeve gastrectomy (LSG), the risk factors for PMVT remain unclear. This study aims to compare the incidence and determinants of PMVT between LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). (2) Methods: A retrospective analysis of 5235 MBSs conducted at our institution between 2015 and 2023 identified five cases of PMVT. Additionally, a systematic review in March 2023, covering PubMed, Web of Science and Scopus, was performed. Several data were analyzed regarding risk factors. (3) Results: In our case series, the incidence of PMVT was 0.1%. The five cases described involved four females with a BMI between 39.7 and 56.0 kg/m2. Their comorbidities were associated with metabolic syndrome, all women used oral contraceptive and two patients were diagnosed with thrombophilia or pulmonary embolism. Per protocol, thromboprophylaxis was administered to all patients. Diagnosis was made at a median of 16 days post-surgery, with abdominal pain being the main presenting symptom. Acute cases were managed with enoxaparin, unfractionated heparin and fibrinolysis. One patient required surgery. Ten studies were included in the systematic review and 205 patients with PMVT were identified: 193 (94.1%) post-LSG and 12 post-LRYGB. The most common comorbidities were dyslipidemia, hypertension, diabetes, sleep apnea and liver disorders; (4) Conclusions: PMVT is a potentially life-threatening complication after MBS, requiring preventive measures, timely diagnosis and several treatments. Our findings suggest a higher occurrence in women with an elevated BMI and post-LSG. Tailored thromboprophylaxis for MBS patients at risk of PMVT may be warranted.
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Affiliation(s)
- Raquel Gomes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | | | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS—Centre for Health Technologies and Services Research, University of Porto, 4200-319 Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
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Arkorful J, Adu – Bredu TK, Otoo O. Detection of Cavernous Transformation of the Portal Vein in a 22-year-old Male with Upper Gastrointestinal Bleeding by Abdominal Duplex Ultrasonography: A Case Report. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:56-60. [PMID: 36794116 PMCID: PMC9923141 DOI: 10.1177/1742271x221098186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Abstract
Introduction Cavernous transformation of the portal vein, although a hepatic condition, may manifest with clinical features similar to those in patients with gastrointestinal pathologies. Particularly in young patients with no prior history of alcoholism or hepatic pathology, the diagnosis of cavernous transformation of the portal vein may be missed in an emergency setting where patients' reported symptoms may be mimicking those associated with bleeding peptic ulcer or other gastrointestinal pathologies. Case Report We present a case of a 22-year-old male with no prior history of hepatic or pancreatic pathology who presented to the emergency room with some episodes of haematemesis, melena and slight dizziness, in whom a cavernous transformation of the portal vein was identified by abdominal duplex ultrasonography. Discussion The clinical diagnosis of cavernous transformation of the portal vein can be challenging and easily missed especially in instances where a patient with no history of chronic alcoholism, liver cirrhosis, hepatoma, pancreatitis or prior abdominal surgery presents to the emergency room with haematemesis and anaemia. Ultrasonography presents as a reliable radiological tool in the diagnosis of rare and unforeseen conditions like cavernous transformation of the portal vein to allow for prompt management and prevention of adverse patients' outcomes. Conclusion Abdominal duplex ultrasonography can reliably aid in the prompt diagnosis and management of patients with unforeseen rare hepatic pathologies such as cavernous transformation of the portal vein who present with upper gastrointestinal bleeding.
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Affiliation(s)
- Joseph Arkorful
- University Hospital, Kwame Nkrumah University
of Science and Technology, Kumasi, Ghana
- Department of Medical Diagnostics, Faculty of
Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana
- Department of Imaging Technology &
Sonography, College of Health and Allied Sciences, University of Cape Coast, Cape-Coast,
Ghana
| | - Theophilus Kofi Adu – Bredu
- Department of Medical Diagnostics, Faculty of
Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana
- Department of Obstetrics and Gynecology,
Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Obed Otoo
- Department of Medical Diagnostics, Faculty of
Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana
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Alkassis S, Zaher N, Kaloti Z, Levine D. Idiopathic portal vein thrombosis not related to hepatic disease or malignancy. BMJ Case Rep 2021; 14:e245620. [PMID: 34753728 PMCID: PMC8578946 DOI: 10.1136/bcr-2021-245620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/03/2022] Open
Abstract
Acute portal vein thrombosis (PVT) is a rare disorder defined by the sudden occlusion of the portal vein, which could be partial or complete. Prothrombotic states, inherited or acquired, are thought to be the cause in patients without cirrhosis or malignancy. However, the aetiology of some cases remains idiopathic despite a multidisciplinary diagnostic approach. The initial diagnostic modality to confirm PVT is either contrast-enhanced abdominal (CT) or MRI; as it can identify predisposing factors, and detect evidence of complications. Eliciting the underlying aetiology is critical to guide overall management and prevent future recurrence. The purpose of treatment is to stop thrombus extension and achieve portal vein patency by anticoagulation to optimise outcomes. Herein, we present an unusual case of spontaneous PVT in a young woman. We will also discuss the evaluation of patients without obvious aetiology.
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Affiliation(s)
- Samer Alkassis
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Nathan Zaher
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Zaid Kaloti
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Diane Levine
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Ghumman GM, Ishtiaq R, Avasthi D. Portal Vein Thrombosis in a Patient With Methylenetetrahydrofolate Reductase Gene Mutation and Normal Homocysteine Levels. Cureus 2021; 13:e18225. [PMID: 34722031 PMCID: PMC8544635 DOI: 10.7759/cureus.18225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 01/21/2023] Open
Abstract
A 21-year-old male presented with chief complaints of abdominal pain, nausea, and vomiting and was found to have portal vein thrombosis (PVT) on computed tomography (CT) scan of the abdomen, which was redemonstrated on ultrasound. Thrombophilia workup was negative except that patient was heterozygous for methylenetetrahydrofolate reductase (MTHFR) gene mutation. Homocysteine levels were normal. The patient was started on enoxaparin and discharged on apixaban with the plan to continue anticoagulation for at least six months. Follow-up MRI after four months showed interval improvement of the main portal vein thrombus with the use of Eliquis.
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Affiliation(s)
| | - Rizwan Ishtiaq
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
| | - Deepti Avasthi
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
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Grama A, Pîrvan A, Sîrbe C, Burac L, Ştefănescu H, Fufezan O, Bordea MA, Pop TL. Extrahepatic Portal Vein Thrombosis, an Important Cause of Portal Hypertension in Children. J Clin Med 2021; 10:2703. [PMID: 34207387 PMCID: PMC8235032 DOI: 10.3390/jcm10122703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023] Open
Abstract
One of the most important causes of portal hypertension among children is extrahepatic portal vein thrombosis (EHPVT). The most common risk factors for EHPVT are neonatal umbilical vein catheterization, transfusions, bacterial infections, dehydration, and thrombophilia. Our study aimed to describe the clinical manifestations, treatment, evolution, and risk factors of children with EHPVT. METHODS We analyzed retrospectively all children admitted and followed in our hospital with EHPVT between January 2011-December 2020. The diagnosis was made by ultrasound or contrast magnetic resonance imaging. We evaluated the onset symptoms, complications, therapeutic methods, and risk factors. RESULTS A total of 63 children, mean age 5.14 ± 4.90 (33 boys, 52.38%), were evaluated for EHPVT during the study period. The first symptoms were upper gastrointestinal bleeding (31 children, 49.21%) and splenomegaly (22 children, 34.92%). Thrombocytopenia was present in 44 children (69.84%). The most frequent risk factors were umbilical vein catheterization (46 children, 73.02%) and bacterial infections during the neonatal period (30 children, 47.62%). Protein C, protein S, antithrombin III levels were decreased in 44 of the 48 patients tested. In 42 of these cases, mutations for thrombophilia were tested, and 37 were positive. Upper digestive endoscopy was performed in all cases, revealing esophageal varices in 56 children (88.89%). All children with gastrointestinal bleeding received an octreotide infusion. In 26 children (41.27%), variceal ligation was performed, and in 5 children (7.94%), sclerotherapy. Porto-systemic shunt was performed in 11 children (17.46%), and Meso-Rex shunt was done in 4 children (6.35%). The evolution was favorable in 62 cases (98.41%). Only one child died secondary to severe sepsis. CONCLUSIONS EHPVT is frequently diagnosed in the last period in our region due to the increased use of umbilical vein catheterization. Furthermore, genetic predisposition, neonatal bacterial infections, and prematurity certainly play an important role in this condition. A proactive ultrasound assessment of children with risk factors for EHPVT should be encouraged for early diagnosis and treatment.
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Affiliation(s)
- Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Alexandru Pîrvan
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Claudia Sîrbe
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
| | - Lucia Burac
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
| | - Horia Ştefănescu
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
- Liver Research Club, 400162 Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Imaging, Emergency Clinical Hospital for Children, 400078 Cluj-Napoca, Romania;
| | - Mădălina Adriana Bordea
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, 400112 Cluj-Napoca, Romania; (A.G.); (A.P.)
- Centre for Expertise in Pediatric Liver Rare Diseases, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania;
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Chen AZL, Allaway MGR, Al-Asady R, Richardson A. Management of acute extensive portal vein thrombosis: the complexity and morbidity. BMJ Case Rep 2020; 13:13/6/e234282. [PMID: 32565434 DOI: 10.1136/bcr-2020-234282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A 62-year-old patient was admitted with an acute unprovoked portal vein thrombosis with splenic and mesenteric extension. His progress was complicated by progressive small bowel ischaemia and increasing clot burden despite systemic anticoagulation. This case report describes the use of catheter-directed thrombolysis via a transjugular intrahepatic portosystemic shunt, with the disease and its treatment complicated by a ruptured iatrogenic pseudoaneurysm, abdominal compartment syndrome and small bowel infarction necessitating extensive small bowel resection.
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Affiliation(s)
- Andy Ze Lin Chen
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Rafid Al-Asady
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Arthur Richardson
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
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Martín-Llahí M, Albillos A, Bañares R, Berzigotti A, García-Criado MÁ, Genescà J, Hernández-Gea V, Llop-Herrera E, Masnou-Ridaura H, Mateo J, Navascués CA, Puente Á, Romero-Gutiérrez M, Simón-Talero M, Téllez L, Turon F, Villanueva C, Zarrabeitia R, García-Pagán JC. Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:538-580. [DOI: 10.1016/j.gastrohep.2017.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
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