Management of Portal Vein Thrombosis in a Postpartum Patient Using Combined Endovascular Therapy and Anticoagulation

Portal vein thrombosis (PVT) is a rare but potentially life-threatening condition in the postpartum period. We present the case of a 25-year-old female who developed extensive thrombosis involving the portal vein, superior mesenteric vein, and splenic vein 13 days after an at-home vaginal delivery complicated by manual placenta extraction performed at a hospital. She presented with progressive abdominal pain and was found to have postpartum endometritis, retained products of conception, and ascites. Laboratory evaluation revealed leukocytosis and mild hepatic enzyme elevation, with a largely negative thrombophilia workup. Given the extensive thrombosis involving the portal vein, superior mesenteric vein, inferior mesenteric vein, and splenic vein, accompanied by ascites and multiple risk factors, she underwent urgent catheter-directed thrombolysis and mechanical thrombectomy in addition to systemic anticoagulation. Post-procedural imaging confirmed significant restoration of portal venous flow. The patient was transitioned to oral anticoagulation and discharged in stable condition. This case highlights the importance of early recognition and multidisciplinary management of postpartum PVT. In patients with extensive clot burden or risk factors for failed recanalization, endovascular therapy combined with anticoagulation may offer a superior outcome to anticoagulation alone.