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Myeloproliferative diseases as causative agents of portal and hepatic veins thrombosis  [PDF]
?ulafi? ?.,Milji? P.,Peri?i? M.,?uranovi? S.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0701083c
Abstract: Thrombosis of portal and hepatic veins is one of the most severe complications and most important causes of death of patients with chronic myeloproliferative diseases. Based on results of the past studies, myeloproliferative diseases were the causes of hepatic veins thrombosis in 30% and portal vein thrombosis in 20% of patients. The study presented 4 patients with myeloproliferative diseases complicated by thrombosis of splanchnic veins, aiming at the illustration of issue complexity in diagnostics and therapy. Two patients with portal vein thrombosis and recurring hemorrhage from esophageal varicosity were described. The first case was planned for shunting, while another case sustained bleeding on what account his anticoagulant therapy was discontinued, but it caused mesenterial thrombosis resulting in lethal outcome. Another two patients had hepatic veins thrombosis. Due to frequent, life-threatening bleeding from the esophageal and gastric varices, a patient with chronic Budd-Chiari syndrome and lineal vein thrombosis underwent mesocaval shunting. An immediate postoperative period was manifested by multiple thrombosis and hemorrhages that ended in his death. A patient with the acute Budd-Chiari syndrome was administered myelosuppressants and anticoagulants on time so reperfusion was restored. In myeloproliferative diseases, thrombosis of portal and hepatic veins gives rise to excessive portal hypertension with profuse hemorrhage from the esophageal and gastric varicosity which is difficult to manage because of complex coagulation disorders.
Splenic vein thrombosis with chronic pancreatitis: a case report and literature review
Nasiri SH, Khorgami J, Donboli K
Tehran University Medical Journal , 2008,
Abstract: "nBackground: Chronic pancreatitis and perivasculitis is the most common etiology of splenic vein thrombosis (SVT). Reported in up to 45% of patients with chronic pancreatitis, SVT may also be seen in patients with acute pancreatitis and pancreatic adenocarcinoma. It causes a localized portal hypertension called sinistral portal hypertension. Unlike those with generalized portal hypertension, patients with sinistral portal hypertension are asymptomatic and have normal liver function. Upper gastrointestinal bleeding from gastric varices is a life threatening complication of SVT. In patients with gastrointestinal bleeding secondary to esophageal or gastric varices, late-phase celiac angiography is used to determine the presence SVT. Splenectomy is effective in treating the collateral outflow for patients with massive gastrointestinal bleeding."n"nCase report: a 23-year-old patient with SVT due to chronic pancreatitis with gastrointestinal bleeding. The patient came to the hospital with upper gastrointestinal bleeding of unknown etiology. Diagnostic workups revealed chronic pancreatitis and SVT with bleeding gastric fundal varices, after which the patient underwent splenectomy. A review of current literature on SVT, known etiologies, diagnosis and treatment is discussed
Hipertensión portal extrahepática: trombosis espleno-portal secundaria a déficit de proteína C
López Serrano,P.; Martín Scapa,M. A.; Alemán Villanueva,S.; Vázquez,M.; Cid Gómez,L.;
Anales de Medicina Interna , 2003, DOI: 10.4321/S0212-71992003000900007
Abstract: portal vein thrombosis (pvt) is the most frequent cause of hypertension portal extrahepatic. it is a rare disorder an the main risk factors are cirrhosis, hepatobiliary malignancies and prothrombotic disorders, which have been identified as major risk . therapy with anticoagulants must to be considered in acute portal trombosis or chronic one and proven hypercoagulability. we present the case of a twenty-nine years old patient, with extrahepatic portal hypertension secondary to portal and splenic vein thrombosis, who was diagnosed because of splenomegaly and a coagulation disorder. a protein c deficiency were discovered and anticoagulation and beta-blocker therapy were iniciated. one year later the patient had not presented complications concerning to the disease or to the treatment.
TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach  [PDF]
Natanel Jourabchi,Justin Pryce McWilliams,Edward Wolfgang Lee,Steven Sauk,Stephen Thomas Kee
Case Reports in Radiology , 2013, DOI: 10.1155/2013/635391
Abstract: Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies. 1. Introduction Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established treatment for the complications of portal hypertension. There are few absolute contraindications for TIPS; right-sided heart failure, severe liver failure, and polycystic liver disease are most commonly cited [1, 2]. Portal vein thrombosis increases the technical difficulty of the TIPS procedure, but TIPS is still often desirable due to the high likelihood of variceal bleeding and ascites in these patients [3–5]. As portal vein thrombosis becomes more chronic, the occluded portal vein becomes fibrotic and shrunken, and cavernous transformation occurs, with collateral formation in the hepatic hilum. The occluded portal vein becomes difficult to access by the transjugular route, and even if the portal vein or one of the collaterals is accessed, wire passage across the occluded segment may be difficult or impossible [6]. Some authors have considered cavernous transformation to be a contraindication to TIPS placement [2, 3, 6, 7]. In this report, we describe a novel technique which may increase the technical success of the TIPS
Anticardiolipin antibodies in children with portal vein thrombosis  [cached]
E. Mahir Gülcan,Tufan Kutlu,Tülay Erkan,Fügen ?ullu ?oku?ra?
Turk Pediatri Ar?ivi , 2009,
Abstract: Aim: The aim of this study was to evaluate the frequency of anticardiolipin antibodies in children with portal vein thrombosis and whether anticardiolipin antibodies have effect on thrombosis in the portal vein.Material and Method: IgG and IgM anticardiolipin levels were measured in 20 patients with portal vein thrombosis and in 20 healthy controls using an ELISA method. Results: IgG anticardiolipin levels (GPL unit) were found as 13.9±4.8 in the portal vein thrombosis patients and 4.4±1.9 in the control group (p<0.05) and IgM anticardiolipin levels (MPL unit) were found as 10.4±5.9 in the portal vein thrombosis patients and in 10.4±0.8 in the control group (p>0.05). In seven (35%) portal vein thrombosis patients and in one (5%) in the control group anticardiolipin IgG (p<0.05) and in two portal vein thrombosis patients (10%) and in two in the control group (10%) anticardiolipin IgM (p>0.05) levels were high (>10 GPL and MPL unit). Conclusions: IgG anticardiolipin antibodies are significantly associated with portal vein thrombosis in children. (Turk Arch Ped 2009; 44: 124-6)
Portal vein thrombosis  [cached]
Gian Mario Santamaria,Stefania Morelli,Paola Trucco,Piero Davio
Emergency Care Journal , 2005, DOI: 10.4081/ecj.2005.1.10
Abstract: Acute portal vein thrombosis (PVT) is un uncommon disease that can be seen in the Emergency Department. In the emergency department setting the diagnosis is difficult because of the variety of clinical presentation but in some clinical presentation patterns the diagnosis should be suspected. Regard to the appropriate radiological abdominal images, color flow Doppler ultrasonography can diagnose the fresh thrombus and spiral CT may be complementary in the diagnosis. The diagnosis differentiation between acute and chronic portal vein thrombosis is important for therapeutic management and prognosis. In stable patient the most common therapy is heparin and warfarin but in some cases thrombolysis can be the treatment of choice. In the patients with intestinal infarction the surgical therapy is strongly indicated. Two cases , one of acute and the other of chronic PVT, are presented and discussed.
Portal vein thrombosis complicating appendicitis
AA Ayantunde, SA Debrah
West African Journal of Medicine , 2004,
Abstract: Appendicitis is still the most common acute surgical abdomen all over the world and its complications may be grave. We report an adult case of acute appendicitis complicated by Portal Vein Thrombosis (PVT) and ascending portomesenteric phlebitis treated successfully with antibiotics and anticoagulation with no residual morbidity. Review of published works on the subject matter is also presented. Key Words: Appendicitis, Portal vein thrombosis, Pylephlebitis, Anticoagulation, Appendicectomy Résumé L'appendicite demeure un abdomen chirurgical aigu le plus courant partout dans le monde entier et son implication pourrait être sévère. Nous rapportons le cas d'une appendicite aigue compliquée par Portal Veine Thrombose (PVT) et phlébite portomesentugue ascendant soignée connu du succès avec antibiotiques et anticoagulation avec aucune morbidité résiduelle. Il s'agit également d'une présentation d'un bilan des travaux publiés sur le contenu du recherche. West African Journal of Medicine Vol.23(4) 2004: 332-334
Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen  [cached]
Rastogi Rajul,Bhargava Satish,Bhatt Shuchi,Goel Sandeep
Journal of Indian Association of Pediatric Surgeons , 2008,
Abstract: Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.
Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization  [cached]
Yu Zhang,Tian-Fu Wen,Lu-Nan Yan,Hong-Ji Yang
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i15.1834
Abstract: AIM: To evaluate the predictive value of preoperative predictors for portal vein thrombosis (PVT) after splenectomy with periesophagogastric devascularization. METHODS: In this prospective study, 69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010. The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography. The hepatic congestion index and the ratio of velocity and diameter were calculated before operation. The prothrombin time (PT) and platelet (PLT) levels were measured before and after operation. The patients’ spleens were weighed postoperatively. RESULTS: The diameter of portal vein was negatively correlated with the portal vein flow velocity (P < 0.05). Thirty-three cases (47.83%) suffered from postoperative PVT. There was no statistically significant difference in the Child-Pugh score, the spleen weights, the PT, or PLT levels between patients with PVT and without PVT. Receiver operating characteristic curves showed four variables (portal vein flow velocity, the ratio of velocity and diameter, hepatic congestion index and diameter of portal vein) could be used as preoperative predictors of postoperative portal vein thrombosis. The respective values of the area under the curve were 0.865, 0.893, 0.884 and 0.742, and the respective cut-off values (24.45 cm/s, 19.4333/s, 0.1138 cm/s-1 and 13.5 mm) were of diagnostically efficient, generating sensitivity values of 87.9%, 93.9%, 87.9% and 81.8%, respectively, specificities of 75%, 77.8%, 86.1% and 63.9%, respectively. CONCLUSION: The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.
Isolated Superior Mesenteric Vein Thrombosis in Acute Pancreatitis: A Case Report  [PDF]
Alpha Oumar Toure, Ousmane Ka, Ibrahima Ka, Mamadou Seck, Ousmane Thiam, Mohamadou Lamine Gueye, Ibrahima Konate, Mamadou Cisse, Madieng Dieng, Abdarahmane Dia, Cheikh Tidiane Toure
Case Reports in Clinical Medicine (CRCM) , 2015, DOI: 10.4236/crcm.2015.47049
The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.
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