COVID-19-Associated Portal Vein Thrombosis Post-Cholecystitis

Area of Science:

• Gastroenterology
• Vascular Medicine
• Infectious Diseases

Background:

• Portal vein thrombosis (PVT) is a rare thromboembolic event typically associated with conditions like cirrhosis, malignancy, and pancreatitis.
• COVID-19 has been linked to various thrombotic complications, but PVT remains infrequently reported in this context.
• PVT can lead to severe outcomes, including intestinal infarction and mortality, necessitating timely diagnosis and management.

Observation:

• A 45-year-old male with obesity, hypertension, and diabetes developed acute abdomen due to extensive portal vein and right branch thrombosis.
• The patient's condition occurred post-discharge following treatment for cholecystitis and concurrent COVID-19 pneumonia.
• This presentation is notable as it occurred in the setting of early-stage cirrhosis, a less common predisposing factor for PVT.

Findings:

• This case represents the first reported instance of COVID-19-associated PVT involving extensive thrombosis of the portal vein and its right branch.
• The patient's presentation underscores the potential for COVID-19 to trigger unusual thromboembolic events, even in the presence of pre-existing liver conditions.
• The development of PVT post-cholecystitis in a COVID-19 patient highlights a complex interplay of factors contributing to hypercoagulability.

Implications:

• Increased clinical suspicion for PVT is warranted in COVID-19 patients presenting with abdominal pain or related symptoms.
• Further research is needed to elucidate the prevalence, pathophysiology, and optimal management of PVT in the context of COVID-19.
• Prompt diagnosis and treatment of PVT are critical to prevent complications such as intestinal infarction and mortality in affected patients.