Portomesenteric venous thrombosis as a rare cause of acute abdomen in a young patient: What should be the process of diagnosis and management?
Mehmet İnan1, Tansel Sarıoğlu2, Tülay Hakkı Serhat2
1Department of General Surgery, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
2Department of Radiology, Mağusa Medical Center, Gazimagusa, Turkish Republic of Northern Cyprus
Abstract
To correct portomesenteric venous thrombosis in a young patient with acute abdomen. To discuss the indication for radiological evaluation and laboratory investigation of thrombophilic risk factors and the duration of anticoagulation therapy. We investigated acquired and genetic thrombophilic laboratory risk factors during the diagnostic process in a young woman who was admitted with abdominal pain. Abdominal CT and Doppler US were found to be useful radiological tools in the diagnostic and follow-up process for portomesenteric thrombosis. The investigated thrombophilic factors, PT G20210A, MTHFR C677T and MTHFR A1298C, were positive for heterozygous mutations and high levels of lupus anticoagulant and factor VIII were detected. As a result of anticoagulation treatment, rapid ascites resolution and an improvement in abdominal pain after meals were seen. Follow-up examination after six months showed that the portomesenteric thrombosis had completely resolved. Evaluation by CT is recommended for patients with acute abdomen and ascites, especially if ultrasonography failed to show any specific pathology. Abdominal CT and Doppler US were effective tools for the diagnosis and follow-up of portomesenteric venous thrombosis. Several acquired or genetic thrombophilic factors were identified by laboratory screening in a patient in whom local precipitating factors were absent. For patients with genetic thrombophilic risk factors and thrombosis at an uncommon site in the body, lifelong treatment with anticoagulants is recommended.
Keywords: Portomesenteric venous thrombosis, anticoagulation, acute abdomen
Written informed consent was obtained from patients who participated in this case report.
Externally peer-reviewed.
Concept - M.İ.; Design - M.İ.; Data Collection and/or Processing - M.İ., T.S., H.S.T.; Analysis and/or Interpretation - M.İ., T.S., H.S.T.; Writer - M.İ.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.