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Portal vein thrombosis: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Portal vein thrombosis leads to portal hypertension and subsequently to gastrointestinal bleeding. Diagnosis is based on ultrasound. Treatment is mainly aimed at control and prevention of gastrointestinal bleeding (usually endoscopy or intravenous octreotide), sometimes vascular bypass or beta-blockers; thrombolysis is possible in acute thrombosis.
[ What causes portal vein thrombosis?
Portal vein thrombosis in neonates is usually due to infection of the umbilical cord stump that extends through the umbilical vein into the portal vein. In older children, the source may be acute appendicitis, in which infection enters the portal system, causing inflammation of the portal vein (pylephlebitis), which may lead to thrombosis. Congenital anomalies of the portal vein that cause portal vein thrombosis are usually associated with other congenital defects. In adults, the main causes are surgery (eg, splenectomy), hypercoagulability syndromes (eg, myeloproliferative disorders, protein C or S deficiency), malignancy (eg, hepatocellular carcinoma or pancreatic cancer), cirrhosis, and pregnancy. The cause remains unknown in about 50% of cases.
Symptoms of portal vein thrombosis
Symptoms of portal vein thrombosis rarely develop acutely, except in the case of concurrent mesenteric vein thrombosis, which causes severe abdominal pain. Most symptoms and signs reflect chronic secondary portal hypertension and include splenomegaly (especially in children) and gastrointestinal bleeding. Ascites due to portal hypertension alone is rare and usually indicates hepatocellular dysfunction of another etiology.
Where does it hurt?
Diagnosis of portal vein thrombosis
Portal vein thrombosis may be suspected in patients with manifestations of portal hypertension in the absence of liver cirrhosis and in patients with even minimal liver dysfunction or changes in enzyme activity in the presence of risk factors such as neonatal umbilical cord infection, childhood appendicitis, or hypercoagulable states. The diagnosis is verified by Doppler ultrasound, which demonstrates decreased or absent portal vein blood flow and sometimes thrombosis. If diagnostic difficulties arise, contrast-enhanced MRI or CT is used. Angiography is performed when vascular bypass is planned.
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 lysis of existing thrombi. In neonates and children, treatment is aimed at eliminating the cause (eg, omphalitis, appendicitis). In other cases, therapy is carried out for portal hypertension and bleeding from varicose veins. In case of bleeding, endoscopic ligation (clipping) of veins is usually used. Intravenous administration of octreotide, a synthetic analogue of somatostatin, is effective. Such therapy has reduced the number of bypass operations (eg, mesocaval, splenorenal), which still have the problem of thrombosis and mortality during surgery (from 5 to 50%). Presumably, b-blockers (in combination with nitrates) can be as effective in preventing bleeding as in portal hypertension due to liver cirrhosis, but this requires additional observations.