TIPS thrombosis related to abdominal trauma

Abdominal trauma is a very rare cause of portal vein thrombosis. A 47-year-old woman presenting alcoholic cirrhosis was referred to our institution for refractory ascites. A transjugular intrahepatic portosystemic shunt (TIPS) was placed in October 2008 and the immediate post-operative course was uneventful. The efficiency of the TIPS was regularly checked by Doppler ultrasonography disclosing the complete regression of ascites and the patency of the stent. In February 2009, she was readmitted for recurrence of ascites. One week before admission, the patient reported a fall of a ladder with severe abdominal trauma and pain. The abdominal computed tomography scan showed thrombosis of the portal system extending from the spleno-mesenteric confluence to the portal vein. A mechanical revision of TIPS was realised, associated with local thrombolytic therapy. The clinical course was favourable and the efficiency of the TIPS was therefore regularly checked by Doppler ultrasonography disclosing the complete regression of ascites and the patency of the stent. Exhaustive search of an underlying thrombophilic state was performed to explain the occurrence of extensive portal thrombosis in our patient and identified a protein C deficiency. In conclusion, we report the first case of a patient who presented a TIPS and extensive portal and TIPS thrombosis probably because of an abdominal trauma. Biological screening identified an inherited protein C deficiency, which supports a recent notion that portal vein thrombosis most often occurs when both the local and the systemic aetiological factors are combined.