Levine, md, frcpc abstractcancer and its treatments are wellrecognized risk factors for venous thromboembolism vte. Imaging in clinical decisionmaking for portal vein thrombosis. The distal portal vein and splenic veins were patent, as was a hypertrophied inferior mesenteric vein. Portal vein thrombosis is a welldescribed, infrequent complication of operations that involve the portal or mesenteric veins. Portal vein thrombosis following laparoscopic sleeve. The jak2 v617f mutation frequently occurs in patients with. Portal vein thrombosis is an unusual thrombotic condition not frequently seen in the general population.
Portal vein thrombosis pvt is a serious problem with a high morbidity and mortality, often exceeding 40% of affected patients. Intraarterial thrombolysis via the superior mesenteric artery was commenced with urokinase abbokinase. B indicates cavernous transformation denoted by small venous collaterals filling around the obstructed portal vein. Sixtyseven patients were identified in the electronic. Sep 01, 2017 portal hypertension is defined as a clinical syndrome when portal venous pressure greater than 12 mmhg. Pulmonary embolism and deep venous thrombosis are the two most important manifestations of venous thrombo embolism vte, which is the third most common lifethreatening cardiovascular disease in. Pdf on jan 1, 2018, nicholas bartell and others published the association between nonselective betablockers and portal venous thrombosis in cirrhotic patients. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders.
Know the causes, symptoms, treatment and diagnosis of portal vein thrombosis. The aim of this retrospective study was to describe risk factors, clinical presentation, complications and treatment of portal vein thrombosis in a singlecentre. Venous phase images confirmed complete thrombosis of the superior mesenteric vein with partially occlusive thrombus in the splenic and portal veins. Portal vein thrombosis radiology reference article. The frequency is surprisingly high compared with other abdominal operations. Portal vein thrombosis is no longer a contraindication for tips.
Portal vein thrombus may be either bland andor malignant i. Portal vein thrombosis pvt is a blood clot that causes irregular blood flow to the liver. To assist health care professionals in the management of portal vein thrombosis pvt. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Portal vein thrombosis pvt is the blockage or narrowing of the portal vein by a thrombus. Learn about the symptoms and treatment of this condition. Portal vein thrombosis pvt is caused by various thrombophilic states. Portal vein thrombosis msd manual consumer version. Portal vein thrombus may be either bland andor mali.
It also can be associated with significant morbidity and mortality. Portal vein thrombosis has been associated with umbilical venous catheterization. Portal vein thrombosis after laparoscopic total colectomy for. Portal venous thrombosis after umbilical vein catheterization. Dec 22, 2004 anatomically pvt may be classified into four categories. Portal hypertension develops as a result of obstruction to flow within the portal venous system. Evaluation and management of acute and chronic portal vein. Portal vein thrombosis pvt is one of the most common vascular disorders of the liver with significant morbidity and mortality. It is a rare complication of laparoscopic general surgery that may be potentially life threatening due to mesenteric ischemia or infarction. Mar 21, 2018 portal vein thrombosis is a pathological condition concerning the liver in which the portal vein which carries blood from the intestines to the liver gets blocked or thrombosed as a result of a clot. Oct 24, 2017 portal vein thrombosis pvt is a blood clot that causes irregular blood flow to the liver. Portal vein thrombosis is blockage or narrowing of the portal vein the blood vessel that brings blood to the liver from the intestines by a blood clot.
Imaging revealed the presence of multiple nonocclusive thrombi involving the. Update on management of portal vein thrombosis and the role. Portal hypertension may be caused by intrinsic liver disease, obstruction, or structural changes that result in increased portal venous flow or increased hepatic resistance. It has been associated with trauma, malignancy, inflammatory diseases and cirrhosis 1. Most people have no symptoms, but in some people, fluid accumulates in the abdomen, the spleen enlarges, andor severe bleeding occurs in the esophagus.
This prospective study was done to determine the incidence of neonatal portal venous thrombosis associated with. Portal vein thrombosis pvt is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. Evidence suggests that the absolute risk depends on the tumor type, the stage or extent of the cancer, and treatment with. Portal vein thrombosis pvt refers to an occlusion at the trunk of the hepatic portal vein.
Portal vein thrombosis after laparoscopic sleeve gastrectomy. Feb 23, 2015 portal vein thrombosis is a rare disease, but our understanding of this disorder has improved during the last few years. The portal vein is one of the splanchnic veins, formed at the confluence of the superior mesenteric and splenic veins and carries blood from the gastrointestinal tract to the liver. The presence of pvt should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. Its diagnosis has been facilitated by improvements in imaging techniques, in particular doppler sonography. Portal vein thrombosis pvt is a condition that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver. Update on management of portal vein thrombosis and the. Recently, pvt has been reported in patients after laparoscopic sleeve gastrectomy lsg.
Pvt secondary to underlying vasculitis especially churgstrauss disease is among the rarest presentation. Thrombosis may occur in veins venous thrombosis or in arteries arterial thrombosis. The underlying causes of portal vein thrombosis pvt are frequently multifactorial and include malignancies, progressive chronic liver diseases, processes localized to the epigastrium and hepatobiliary system, and. Causes of pvt are cirrhosis, hepatobiliary malignancy, abdominal infectious or inflam. Portal hypertension is a term used to describe elevated pressures in the portal venous system a major vein that leads to the liver. Although rare, it has been seen after an array of laparoscopic surgeries including bariatric procedures, gastric fundoplications, splenectomies, colectomies and appendectomies. Acute thrombosis of a giant portal venous aneurysm santana.
Portal vein thrombosis pvt is a rare complication of laparoscopic surgery. Large cohort studies have reported a global prevalence of 1%, but in some risk groups it can be up to 26%. Abbott laboratories, north chicago, il at 100,000 uhr and systemic iv heparin. The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine, respectively.
There is a mixing of portal and systemic blood circulation within the sinusoids, and all the blood eventually drains from the liver via the hepatic veins to the inferior vena cava. In developed countries, pvt might be more common than previously considered, as it was found at routine necropsy in about 1% of swedish subjects in the 1970s. An intraoperative color doppler sonogram confirmed the preoperative imaging findings and revealed the giant portal venous aneurysm with thrombosis and a normal pancreas. It is a type of splanchnic vein thrombosis svt, which is a continuum of thrombotic diseases involving any combination of the portal, splenic, mesenteric, and suprahepatic veins. Portal vein thrombosis obstruction of the portal vein or its branches can be related to invasion or constriction by a malignant tumor, or to thrombosis. A new classification system of pvt, based on the site of thrombosis portal venous trunk andor its tributary branches, degree of occlusion, duration and presentation, and associated symptoms, has recently been proposed to delineate this relatively common clinical finding within a heterogenous set of diseases table 2.
What is portal vein thrombosiscausessymptomstreatment. Jun 28, 2019 a new classification system of pvt, based on the site of thrombosis portal venous trunk andor its tributary branches, degree of occlusion, duration and presentation, and associated symptoms, has recently been proposed to delineate this relatively common clinical finding within a heterogenous set of diseases table 2. Aug 15, 2007 portal vein thrombosis pvt is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. Portal vein thrombosis may be seen in a variety of clinical contexts, and when acute can be a lifethreatening condition. Portal vein pv is the main vessel in the portal venous system and drains blood from the gastrointestinal tract and spleen to the liver. Pdf the association between nonselective betablockers. It is a major cause of noncirrhotic presinusoidal portal hypertension. The prevalence is about 1% in the general population, but much higher rates. The following describes the presentation of pvt in a young male, the search for risk factors and underlying etiology, and the debate of anticoagulation therapy. Mesenteric and portal venous thrombosis treated by. Etiology and complications of portal vein thrombosis. Neonatal portal vein thrombosis pvt has been described as a rare event, but is becoming more commonly recognized. Congenital and acquired anomalies of the portal venous system.
Estimates range from 1 in 100,000 live births 1 to 36 per neonatal intensive care unit admissions. Acute portal vein thrombosis unrelated to cirrhosis. Portal vein thrombosis pvt is a rare cause of portal hypertension. Portal vein thrombosis pvt in the general population is a rare event, but it occurs relatively frequently in patients with liver cirrhosis and its prevalence increases with the severity of the disease. Venous thrombosis leads to congestion of the affected part of the body, while arterial thrombosis and rarely severe venous thrombosis affects the blood supply and leads to damage of the tissue supplied by that artery ischemia and necrosis. Abdominal imaging with computed tomography ct demonstrating a nonenhancing luminal filling defect in the portal vein or abdominal ultrasound demonstrating echogenic thrombus with absent doppler flow in the portal vein is consistent with a diagnosis of pvt. Portal venous system an overview sciencedirect topics. The portal venous system drains the intestines, pancreas, and spleen with numerous collateral anastomoses to other venous beds of the abdomen.
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