[Portal vein thrombosis and mesenteric venous ischemia]

Portal vein thrombosis (PVT) in the absence of underlying chronic liver disease is a rare disease and is frequently associated with prothrombotic factors. In patients with cirrhosis, the frequency of PVT increases with the severity of cirrhosis. The main symptoms of recent PVT include abdominal pain and an increase in C-reactive protein (CRP). The main symptoms of chronic PVT are manifestations of portal hypertension (esophageal varices, thrombocytopenia, splenomegaly). The diagnosis of PVT is fortuitous in 30% of cases. Computed tomography or magnetic resonance imaging (MRI) with acquisitions without injection, at the arterial, portal, and tardive phase are mandatory to confirm the diagnosis and assess complications. Mesenteric ischemia is a medical and surgical emergency and represents the most severe complication of PVT. It must be systematically investigated using imaging. Surgery should be considered when intestinal necrosis is suspected, namely in cases of hyperlactatemia and associated organ failure. Anticoagulant therapy is the first-line treatment of recent and chronic PVT. Its modalities are based on a case-by-case assessment, considering features of thrombosis, comorbidities, and the therapeutic plan. In case of failure of anticoagulant therapy and/or severe manifestations, radiological portal vein recanalization may be considered. Treatment in a center with expertise in vascular liver diseases is recommended.