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Portal portal thrombosis: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Thrombosis of the portal vein leads to portal hypertension and subsequently to gastrointestinal bleeding. Diagnosis is based on ultrasound. The treatment is mainly directed to the control and prevention of gastrointestinal bleeding (usually endoscopy or intravenous octreotide), sometimes vascular bypass or b-blockers; with acute thrombosis, thrombolysis is possible.
[What causes thrombosis of the portal vein?
Portal vein thrombosis in newborns is usually associated with an infection of the umbilical stump, which spreads through the umbilical vein into the portal vein. In older children, the source can be acute appendicitis, in which the infection enters the portal system, causing portal vein inflammation (pylephlebitis), which can lead to thrombosis. Congenital anomalies of the portal vein causing its thrombosis are usually combined with other congenital defects. In adults, the main causes are surgical interventions (eg, splenectomy), hypercoagulable syndrome (eg, myeloproliferative disorders, deficiency of protein C or S), a malignant tumor (eg hepatocellular carcinoma or pancreatic cancer), cirrhosis and pregnancy. The reason remains unidentified in about 50% of cases.
Symptoms of portal vein thrombosis
Symptoms of portal vein thrombosis rarely develop acute, with the exception of concomitant thrombosis of mesenteric veins, which causes severe pain abdominal syndrome. Most of the symptoms and signs reflect a chronic secondary portal hypertension and include splenomegaly (especially in children) and gastrointestinal bleeding. Ascites only rarely develop due to portal hypertension and, as a rule, indicate hepatocellular dysfunction of another etiology.
Where does it hurt?
Diagnosis of portal vein thrombosis
Thrombosis of the portal vein can be suspected in patients with manifestations of portal hypertension in the absence of cirrhosis and in patients with even minimal impairment of liver function or changes in enzyme activity in the presence of risk factors such as neonatal cord infection, appendicitis in childhood, or hypercoagulable conditions. Diagnosis is verified using Doppler ultrasound, which demonstrates a decrease or absence of blood flow through the portal vein and sometimes thrombosis. If the diagnosis is difficult, use MRI or CT with contrast enhancement. When planning vascular bypass, angiography is performed.
What do need to examine?
How to examine?
Treatment of portal vein thrombosis
In acute cases of thrombosis, anticoagulant therapy sometimes prevents its spread, but does not lead to the lysis of existing thrombi. In newborns and children, treatment is aimed at eliminating the cause (eg, omphalitis, appendicitis). In all other cases, portal hypertension and bleeding from varicose veins are treated. When bleeding is usually used endoscopic ligation (clipping) of veins. Effective intravenous administration of octreotide is a synthetic analogue of somatostatin. Such therapy reduced the number of shunting operations (for example, mesocaval, splenorenal), in which the problem of thrombosis and mortality during surgery (from 5 to 50%) remains. Presumably, b-blockers (in combination with nitrates) can be equally effective in preventing bleeding, as in portal hypertension due to cirrhosis, but this requires additional observations.