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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.

Sinagra E, Aragona E, Romano C, Maisano S, Orlando A, Virdone R, Tesè L, Modesto I, Criscuoli V, Cottone M - Gastroenterol Res Pract (2012)

Bottom Line: Inflammatory bowel diseases are associated with an increased risk of vascular complications.In two of them, hepatic abscess was present.Furthermore, we performed a systematic review based on the clinical literature published on this topic.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, DIBIMIS, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Via Trabucco 180, 90100 Palermo, Italy.

ABSTRACT
Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.

No MeSH data available.


Related in: MedlinePlus

Residual portal cavernoma showed at CT scan.
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fig2: Residual portal cavernoma showed at CT scan.

Mentions: A 66-year-old woman, with a 10-year diagnosis of inflammatory ileal Crohn's disease (CD), on treatment with budesonide for active disease, was admitted to our unit for fever with chills. There was no history of previous thromboembolic events. Physical examination revealed tachycardia, without any abdominal tenderness or masses; blood tests showed leucocytosis (13000 white blood cells (WBC)/mm3), thrombocytosis (360000 platelets/mm3), and increased ESR (25 mm/Ih) and PCR (18 mg%); 3 blood cultures isolated Gemella Haemolysans and Sphingomonas paucimobilis. Ultrasound (US) doppler and computer tomography (CT) scan showed a small abscess in liver l and PVT extending to the intrahepatic branches (Figure 1). Coagulation study did not show any abnormalities (antithrombin, protein C and S activity, plasma homocysteine level, PT, and aPTT were normal) and no mutation was detected in factor II, V, MTHFR, and PAI-I genes; antibody anticardiolipin and antiphospholipid antibodies were negative; no mutation of JAK-2 gene was found. The patient was treated with low-molecular-weight heparin (LMWH) (1 mg/kg/twice daily) and imipenem on the basis of the blood culture results for 3 weeks and then amoxicillin/clavulanic acid for further 2 weeks on the basis of the results of blood culture and relative sensibility testing, with disappearance of fever. A further US Doppler, performed one month after, showed a complete patency of portal three and disappearance of hepatic abscesses. LMWH was suspended after 3 months. At the last outpatient control, the patient had optimal clinical and nutritional status, while US Doppler showed a residual portal cavernoma, confirmed at CT scan (Figure 2).


The role of portal vein thrombosis in the clinical course of inflammatory bowel diseases: report on three cases and review of the literature.

Sinagra E, Aragona E, Romano C, Maisano S, Orlando A, Virdone R, Tesè L, Modesto I, Criscuoli V, Cottone M - Gastroenterol Res Pract (2012)

Residual portal cavernoma showed at CT scan.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475311&req=5

fig2: Residual portal cavernoma showed at CT scan.
Mentions: A 66-year-old woman, with a 10-year diagnosis of inflammatory ileal Crohn's disease (CD), on treatment with budesonide for active disease, was admitted to our unit for fever with chills. There was no history of previous thromboembolic events. Physical examination revealed tachycardia, without any abdominal tenderness or masses; blood tests showed leucocytosis (13000 white blood cells (WBC)/mm3), thrombocytosis (360000 platelets/mm3), and increased ESR (25 mm/Ih) and PCR (18 mg%); 3 blood cultures isolated Gemella Haemolysans and Sphingomonas paucimobilis. Ultrasound (US) doppler and computer tomography (CT) scan showed a small abscess in liver l and PVT extending to the intrahepatic branches (Figure 1). Coagulation study did not show any abnormalities (antithrombin, protein C and S activity, plasma homocysteine level, PT, and aPTT were normal) and no mutation was detected in factor II, V, MTHFR, and PAI-I genes; antibody anticardiolipin and antiphospholipid antibodies were negative; no mutation of JAK-2 gene was found. The patient was treated with low-molecular-weight heparin (LMWH) (1 mg/kg/twice daily) and imipenem on the basis of the blood culture results for 3 weeks and then amoxicillin/clavulanic acid for further 2 weeks on the basis of the results of blood culture and relative sensibility testing, with disappearance of fever. A further US Doppler, performed one month after, showed a complete patency of portal three and disappearance of hepatic abscesses. LMWH was suspended after 3 months. At the last outpatient control, the patient had optimal clinical and nutritional status, while US Doppler showed a residual portal cavernoma, confirmed at CT scan (Figure 2).

Bottom Line: Inflammatory bowel diseases are associated with an increased risk of vascular complications.In two of them, hepatic abscess was present.Furthermore, we performed a systematic review based on the clinical literature published on this topic.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, DIBIMIS, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Via Trabucco 180, 90100 Palermo, Italy.

ABSTRACT
Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.

No MeSH data available.


Related in: MedlinePlus