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

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.