The Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature

Sinagra, Emanuele; Aragona, Emma; Romano, Claudia; Maisano, S.; Orlando, Ambrogio; Virdone, Roberto; Tesè, Lorenzo; Modesto, Irene; Criscuoli, Valeria; Cottone, Mario

doi:10.1155/2012/916428

Cited by 16 publications

(19 citation statements)

References 50 publications

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“…Deep vein thrombosis and pulmonary embolism account for the majority of thromboembolic events in patients with IBD, as in the general population. The incidence of PVT is also higher in patients with IBD than in the general population 10. The mortality rate of untreated PVT in IBD has previously been reported to be as high as 50%, but treatment with low-molecular-weight heparin is usually effective 10.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of PVT is also higher in patients with IBD than in the general population 10. The mortality rate of untreated PVT in IBD has previously been reported to be as high as 50%, but treatment with low-molecular-weight heparin is usually effective 10. The European Crohn's and Colitis Organisation (ECCO) therefore recommends thromboprophylaxis in all hospitalised patients with IBD 9.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease

et al. 2015

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SUMMARYA 27-year-old man developed extensive hepatic portal venous gas (HPVG) shortly after staging colonoscopy for active, ulcerating, terminal ileal Crohn's disease. Nonoperative management was instigated with broadspectrum antibiotics and thromboprophylaxis. Radiology at 72 h demonstrated resolution of HPVG but revealed fresh non-occlusive left portal vein thrombus. Anticoagulation with warfarin was continued for 1 year, during which the thrombus initially progressed and then organised with recanalisation of the portal vein. There were no long-term clinical consequences. HPVG has previously been documented as a rare complication of inflammatory bowel disease and endoscopic intervention. We hypothesise that the barotrauma sustained during endoscopy, in association with active ulceration and mucosal friability, predisposes to the influx of gas and bacteria into the portal system. We describe successful non-operative management of HPVG in this setting and draw attention to an additional complication of portal venous thrombosis, highlighting the importance of thromboprophylaxis and serial radiological examination. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease

et al. 2015

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“…1% to 2% of patients with IBD have been found to have thrombosis of the portal and the mesenteric veins [162]. IBD patients are hypercoagulable with elevated platelets, fibrinogen, factor V and VIII levels and reduced anti-thrombin III levels [163,164].…”

Section: Portal Vein Thrombosismentioning

confidence: 99%

“…A six month course of anticoagulation has been instituted at various centers. However lifelong systemic anticoagulation is indicated in known congenital hypercoagulable states [162].…”

Section: Portal Vein Thrombosismentioning

confidence: 99%

A review of liver disorders in inflammatory bowel disease (IBD)

Shah¹,

Gupta²,

Borg³

2017

Clin Case Rep Rev

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Disorders of the liver and the biliary tract are frequently the extraintestinal manifestations of inflammatory bowel disease (IBD). The etiology of these hepato-biliary conditions is deemed secondary to their shared pathogenesis, the chronic effects of a long term, ongoing inflammation of the bowels, along with the medications used to manage IBD. For up to 30% of patients with IBD, abnormal liver biochemical tests are present. Other, selected patients with IBD are followed for reactivation of hepatitis B, through guidelines only relatively recently in place. The vast realm of related clinical conditions does not always correspond well with IBD severity, which can range from mild hepatic insult to end-stage liver disease, necessitating liver transplantation. Hence it is critical to follow its presence, clinical course and long term consequences. Moreover, the management of these disorders is necessarily individualized, with some patients requiring frequent monitoring and others a more multi-disciplinary approach. Studies aimed at improving the outcomes of patients with IBD who experience associated liver and biliary tract disorders are now needed to assess early identification, possible screening approaches and more effective systems of referral. This article covers the evidence-based literature on topics detailing the co-existence of liver conditions in inflammatory bowel disease with a focus on its epidemiology, clinical manifestations, diagnosis and management.

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“…Previous studies have shown that the occurrence of PMVT in IBD patients in the post-operative setting was not associated with adverse clinical outcomes and most patients recovered uneventfully [ 12 , 13 , 16 ]; however, PMVT can also occur in IBD patients without any history of abdominal or pelvic surgery [ 14 , 15 , 17 , 18 ]. The risk factors and the impact of non-surgery-related PMVT on the clinical course of IBD have not been systematically studied.…”

Section: Introductionmentioning

confidence: 99%

Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

Arora

Navaneethan

et al. 2015

Gastroenterol. Rep.

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Objective: Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis (PMVT) and its impact on the outcomes of inflammatory bowel diseases (IBD).Methods: All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record (study group; n = 20). Patients were matched for age, sex, and IBD phenotype with control IBD patients who had no PMVT, with a ratio of 1:3 (control group; n = 60). Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two groups.Results: Of the 20 patients in the Study group, 6 (30%) had UC, 14 (70%) had CD and 11 (55%) were male. On multivariable analysis, inpatient status (odds ratio [OR] 6.88; 95% confidence interval [CI] 1.88–25.12) and baseline corticosteroid use (OR 4.39; 95% CI 1.27–15.19) were found to be independent risk factors for the development of PMVT. At one-year follow-up, PMVT patients were more likely to have an adverse outcome of IBD, including subsequent emergency room visit (26.3% vs. 1.7%; P = 0.003), hospitalization for medical management (60.0% vs. 20.0%; P = 0.001) or IBD-related surgery (65.0% vs. 26.7%; P = 0.003) than the non-PMVT controls. In multivariable analysis, PMVT (OR 5.19; 95% CI 1.07–25.28) and inpatient status (OR 8.92; 95% CI 1.33–59.84) were found to be independent risk factors for poor outcome, whereas baseline immunomodulator use (OR 0.07; 95% CI 0.01–0.51) was found to be a protective factor.Conclusions: IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of PMVT. The presence of PMVT was associated with poor clinical outcomes in IBD.

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The Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature

Cited by 16 publications

References 50 publications

Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease

Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease

A review of liver disorders in inflammatory bowel disease (IBD)

Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

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