Episode 943: Portal Vein Thrombosis

Contributor: Travis Barlock, MD

Educational Pearls:

What is Portal Vein Thrombosis?

• The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancreas, and spleen to the liver

• Not only can this cause problems downstream in the liver, but the backup of venous blood can cause ischemia in the bowels

How does it present?

• Similar to acute mesenteric ischemia: Sudden onset of abdominal pain, nausea, vomiting, and fever

How is it diagnosed?

• Abdominal CT or MRI with contrast

What causes it?

• Cirrhosis

• Coagulopathy (Factor V Leiden mutation, Prothrombin gene mutation, Antiphospholipid syndrome, Protein C, protein S, antithrombin III deficiency, etc.)

• Oral Contraceptive Pills (OCPs)

• Cancer such as hepatocellular carcinoma

How is it treated?

• Aggressive fluid resuscitation

• Antibiotics. Be sure to cover enteric gram-negative bacteria and anaerobes

• Heparin, same dosing as a bolus for a DVT

• Endovascular treatment, such as a thrombectomy with IR

• Surgical evaluation if there has been tissue death in the mesentery

References

• Hilscher, M. B., Wysokinski, W. E., Andrews, J. C., Simonetto, D. A., Law, R. J., & Kamath, P. S. (2024). Portal Vein Thrombosis in the Setting of Cirrhosis: Evaluation and Management Strategies. Gastroenterology, 167(4), 664–672. https://doi.org/10.1053/j.gastro.2024.05.017

• Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2019). Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients With and Without Cirrhosis. Gastroenterology, 156(6), 1582–1599.e1. https://doi.org/10.1053/j.gastro.2019.01.265

• Ju, C., Li, X., Gadani, S., Kapoor, B., & Partovi, S. (2022). Portal Vein Thrombosis: Diagnosis and Endovascular Management. Pfortaderthrombose: Diagnose und endovaskuläres Management. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 194(2), 169–180. https://doi.org/10.1055/a-1642-0990

Summarized by Jeffrey Olson MS3 | Edited by Jorge Chalit, OMS3

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