Massive portal vein thrombosis and kidney rupture following blunt abdominal trauma: A diagnostic and therapeutic dilemma

Riesen, S. van; Wasowicz-Kemps, D.K.; Besselink, M.; Bollen, Thomas L.; Vos, Jan Albert; Onaca, M.G.; Segers, M.J.M.

doi:10.1016/j.injury.2007.07.002

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…The pathogenesis of portal venous thrombosis in our case could be embolic phenomenon from smaller vessels from shattered spleen (although there was no evidence of thrombus in splenic vein) or it could have formed in situ secondary to shearing endothelial injury. [ 6 8 ] Our case is also unique in the sense that the acute nature of the portal venous thrombosis can be confidently ascertained due to the hyperdense appearance of thrombus on non-contrast computed tomography, which has not been reported previously.…”

Section: Discussionmentioning

confidence: 59%

“…It is usually administered for longer periods for more widespread thrombosis. [ 7 8 ] In our case, the thrombus was in the right branch of the portal vein and there were no signs of bowel ischemic or hepatic infarction, therefore, primary treatment was aimed as splenic injury with delayed institution of anticoagulant therapy. [ 3 8 ] Potential complication of untreated portal venous thrombosis is portal hypertension but may also lead to ischemic bowel stricture if thrombosis extends into mesenteric venous arches.…”

Section: Discussionmentioning

confidence: 96%

“…It has been reported both as an isolated entity[ 1 2 3 7 ] and in association with other organ injuries such as pancreatic and renal injures. [ 4 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 3 4 5 6 ] One reported case in the literature was associated with an underlying coagulation disorder,[ 7 ] and in another case, acute nature of thrombosis was inferred form indirect evidence. [ 8 ] There are reports of portal venous thrombosis in association with hepatic or pancreatic laceration and ruptured kidney;[ 4 6 8 ] there is no report of acute traumatic portal venous thrombosis in association with shattered spleen. We report multidetector computed tomography (MDCT) findings in a young patient with a shattered spleen and acute portal venous thrombosis in right branch of portal vein.…”

Section: Introductionmentioning

confidence: 99%

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Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Gupta

Mittal

Sekhon

et al. 2017

Indian Journal of Radiology and Imaging

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Post-traumatic portal venous thrombosis is a rare event, and is usually seen in association with penetrating injuries. Portal venous thrombosis following blunt abdominal trauma is extremely rare with only few reports in the literature, some associated with underlying coagulation disorders. We report multidetector computed tomography findings in a case of blunt abdominal trauma with otherwise normal coagulation profile, which showed shattered spleen and MDCT evidence of acute thrombosis in the right branch of the portal vein. To the best of our knowledge, this is the first documented report of acute portal venous thrombosis in association with shattered spleen.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 96%

“…It has been reported both as an isolated entity[ 1 2 3 7 ] and in association with other organ injuries such as pancreatic and renal injures. [ 4 8 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Gupta

Mittal

Sekhon

et al. 2017

Indian Journal of Radiology and Imaging

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“…A literature review identified three cases where an exhaustive search for a cause had failed to reveal an alternative aetiology 6–8…”

Section: Discussionmentioning

confidence: 99%

Thrombosis of the portal venous system following blunt abdominal trauma

Rajkomar

Kyerematen²,

Mysore³

et al. 2010

Case Reports

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A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system. BACKGROUND

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A case of portal vein thrombosis caused by blunt abdominal trauma in a patient with low protein C activity

Nishimura

Misawa

Kitamura

et al. 2018

Clin J Gastroenterol

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Portal vein thrombosis (PVT) is caused by several conditions including infection, malignancies, surgery, medications, and coagulation disorders. However, PVT caused by low-energy injury is very rare. A 51-year-old man visited a clinic with a 2-day history of abdominal pain following blunt abdominal trauma. Contrast-enhanced computed tomography (CT) revealed thrombosis in both the portal vein and splenic vein, and he was transferred to our hospital with a diagnosis of PVT. Anticoagulant therapy was initiated using unfractionated heparin. A repeat CT scan revealed enlargement of the thrombus, which occluded the main trunk and first right branch of the portal vein. Laboratory data before heparin administration suggested low protein C activity. Anticoagulation therapy was continued with intermittent assessment of the size of the thrombus and degree of coagulation. On day 23, enhanced CT showed marked shrinkage of the thrombus compared with that on day 8. On day 30, the patient was discharged with a therapeutic prothrombin time-international normalized ratio. Here we present a case of PVT caused by low-energy trauma of the upper abdomen in a patient with a background of low protein C activity that was successfully treated without invasive surgery.

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Massive portal vein thrombosis and kidney rupture following blunt abdominal trauma: A diagnostic and therapeutic dilemma

Cited by 4 publications

References 18 publications

Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Acute post traumatic portal venous thrombosis associated with shattered spleen: A case report

Thrombosis of the portal venous system following blunt abdominal trauma

A case of portal vein thrombosis caused by blunt abdominal trauma in a patient with low protein C activity

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