Journal of University of Malaya Medical Centre 2019;22(1):8-12

doi:10.2013my0157

AN UNUSUAL CASE OF PORTAL, SPLENIC AND MESENTERIC VENOUS THROMBOSIS PRESENTING WITH ACUTE ABDOMEN

Yeoh CN 1 ; R Nadiah 2 ; Cheah SK 1 ; Wan Mat WR 1 ; M Maaya 1 ; AR Raha 1

Affiliations

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Keywords

Acute Abdomen; Mesenteric Vein Thrombosis; Non-Cirrhotic Vein Thrombosis; Portal Vein Thrombosis; Splenic Vein Thrombosis

Country

Malaysia

Language

English

Abstract

Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia. Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis