open access

Vol 18, No 4 (2012)
Case reports
Published online: 2013-01-01
Get Citation

Portal vein thrombosis as a late-diagnosed, rare cause of bowel infarction: a case report

Jacek Budzyński, Joanna Wiśniewska, Grzegorz Pulkowski
Acta Angiologica 2012;18(4):183-188.

open access

Vol 18, No 4 (2012)
Case reports
Published online: 2013-01-01

Abstract

This case report presents a female patient in the puerperal period with abdominal pain recurring for 10 days
in whom bowel infarction occurred. In a computerized tomography angiography (CTA) made after bowel
resection, superior mesenteric artery (SMA) occlusion was diagnosed. The patient was referred for SMA
stenting. However, analysis of the clinical course of the disease and ultrasonographic examination suggested
the possibility of portal and superior mesenteric vein (SMV) thrombosis as a cause of bowel infarction. This
was confirmed in the second CTA. Additionally, signs of portal hypertension in CTA and panendoscopy were
diagnosed. Anticoagulation with warfarin for thrombosis and carvedilolum for portal hypertension reduction
were recommended. Sclerotherapy was performed three times with histoacryl and polidocanol due to the
progression of the gastric fundal varices. A diagnostic examination made in order to determine the cause of the
thrombotic process showed only a mutation in the heterozygous tetrahydrofolate reductase (MTHFR) gene.
Diagnostic difficulties were described, and practical suggestions for the diagnosis of the basic disorder and its
complications were made. Rationales for therapy were discussed.

Abstract

This case report presents a female patient in the puerperal period with abdominal pain recurring for 10 days
in whom bowel infarction occurred. In a computerized tomography angiography (CTA) made after bowel
resection, superior mesenteric artery (SMA) occlusion was diagnosed. The patient was referred for SMA
stenting. However, analysis of the clinical course of the disease and ultrasonographic examination suggested
the possibility of portal and superior mesenteric vein (SMV) thrombosis as a cause of bowel infarction. This
was confirmed in the second CTA. Additionally, signs of portal hypertension in CTA and panendoscopy were
diagnosed. Anticoagulation with warfarin for thrombosis and carvedilolum for portal hypertension reduction
were recommended. Sclerotherapy was performed three times with histoacryl and polidocanol due to the
progression of the gastric fundal varices. A diagnostic examination made in order to determine the cause of the
thrombotic process showed only a mutation in the heterozygous tetrahydrofolate reductase (MTHFR) gene.
Diagnostic difficulties were described, and practical suggestions for the diagnosis of the basic disorder and its
complications were made. Rationales for therapy were discussed.
Get Citation

Keywords

portal vein thrombosis; mesenteric vein thrombosis; acute mesenteric ischaemia; bowel infarction; puerperal period

About this article
Title

Portal vein thrombosis as a late-diagnosed, rare cause of bowel infarction: a case report

Journal

Acta Angiologica

Issue

Vol 18, No 4 (2012)

Pages

183-188

Published online

2013-01-01

Bibliographic record

Acta Angiologica 2012;18(4):183-188.

Keywords

portal vein thrombosis
mesenteric vein thrombosis
acute mesenteric ischaemia
bowel infarction
puerperal period

Authors

Jacek Budzyński
Joanna Wiśniewska
Grzegorz Pulkowski

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl