Pregnancy Complicated by Extrahepatic Portal Vein Occlusion and Portal Vein Thrombosis: A Case Report
Shingo Hosomi1, Rie Oyama1, Chizuko Isurugi1
1Obstetrics and Gynecology, Iwate Medical University, Yahaba-cho, JPN.
We report the case of a 38-year-old woman with a history of extrahepatic portal vein obstruction (EHPVO) who became pregnant and developed portal vein thrombosis. She gave birth after intervention by gastroenterology and cardiology. She was referred to our department due to significant leg edema at eight weeks of gestation, and we noticed EHPVO, portal vein thrombosis, and left pulmonary arteriovenous fistula by contrast-enhanced CT. Therefore, subcutaneous heparin injections of 10,000 units/day were started as a preventive anticoagulant therapy. We performed an emergency cesarean section at 36 weeks of gestation. After surgery, the mother was administered a continuous heparin infusion. On the 11th day after surgery, the postoperative progress was good, so heparin was switched to oral warfarin, and the patient was discharged on the same day. During pregnancy, the risk of varicose vein rupture, hyperammonemia, and pulmonary hypertension increases due to an increase in circulating blood volume. This was a case in which careful perinatal management was performed in collaboration with other departments, resulting in a live birth.
We report the case of a 38-year-old woman with a history of extrahepatic portal vein obstruction (EHPVO) who became pregnant and developed portal vein thrombosis. She gave birth after intervention by gastroenterology and cardiology. She was referred to our department due to significant leg edema at eight weeks of gestation, and we noticed EHPVO, portal vein thrombosis, and left pulmonary arteriovenous fistula by contrast-enhanced CT. Therefore, subcutaneous heparin injections of 10,000 units/day were started as a preventive anticoagulant therapy. We performed an emergency cesarean section at 36 weeks of gestation. After surgery, the mother was administered a continuous heparin infusion. On the 11th day after surgery, the postoperative progress was good, so heparin was switched to oral warfarin, and the patient was discharged on the same day. During pregnancy, the risk of varicose vein rupture, hyperammonemia, and pulmonary hypertension increases due to an increase in circulating blood volume. This was a case in which careful perinatal management was performed in collaboration with other departments, resulting in a live birth.
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