Portal vein thrombosis (PVT): a study of 20 non-cirrhotic cases

Portal and mesenteric venous thrombosis (PVT) is an uncommon disease with serious consequences if not discovered early in order to prevent complications such as variceal bleeding and intestinal ischaemia. The objective of this study was to describe the clinical presentation and outcome of patients with PVT with a view to early diagnosis and treatment of this disease. The study was restricted to patients with PVT not caused by underlying liver cirrhosis.

To analyse important clinical characteristics of this entity we performed a retrospective study of 20 non-cirrhotic patients seen in our hospital from February 1998 to March 2003.

The main clinical symptom was abdominal pain (13 patients, 86%), sometimes in combination with diarrhoea and vomiting (5 patients, 33%), nausea and anorexia (3 patients). Laboratory signs were non-specific and diagnosis was usually by computed tomography (19 patients, 95%). Causative factors included prothrombotic states (9 patients, 45%) and/or local factors (5 patients, 25%). Complications must be expected from portal hypertension (15 patients, 75%), which was associated with variceal bleeding in 6 patients (30%). Bowel ischaemia (5 patients, 25%) and bowel infarction (2 patients) were less frequent. Treatment consisted of immediate anticoagulation in almost all cases (18 patients, 90%), while invasive approaches were followed in selected patients. The prognosis of PVT was good in patients without a severe underlying disease (median followup 21 months).

In agreement with other studies our results suggest that early diagnosis and treatment by immediate anticoagulation are important in preventing the serious consequences of portal and mesenteric vein occlusion. The role of more invasive approaches is less well defined. Since in 18 patients (90%) of the non-cirrhotic cases in the present series causative factors were found which may have therapeutic implications, aetiological screening seems worthwhile in every case with PVT.