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Iatrogenic fine needle aspiration of abdominal masses etc. PVT can be classified into four categories, depending on the extension: Recent portal or mesenteric venous thrombosis: Published online Jan High risk of cerebral-vein thrombosis in carriers of a prothrombin-gene mutation and in users of oral contraceptives.
Meta-analysis of the risk of venous thrombosis in individuals with antiphospholipid antibodies without underlying autoimmune disease or previous thrombosis. Splanchnic vein thrombosis in candidates for liver transplantation: MR imaging of complications after liver transplantation.
However, these data have not been confirmed and features of liver transplantation, comparing recipients with PVT and those without, are similar[ 74- ]. Despite lla activation of this complex system of support, the impairment of portal flow has important consequences on liver tissue.
Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment
Transjugular intrahepatic portosystemic shunt. Several etiological causes, either of local or systemic origin, might be responsible for PVT development, although more than one factor is often identified.
Nowadays, anticoagulant therapy is the best way to obtain portal vein recanalization; however, there is no consensus on its application.
Consider a diagnosis of acute PVT in any patient with abdominal pain of more than 24 h duration, whether or not there is also fever or ileus. The presence of ascites, thinning of the intestinal wall, lack of mucosal enhancement of the thickened intestinal wall, or the development of multiorgan failure indicate that intestinal infarction is likely and surgical exploration should be considered.
Other approaches, such as transjugular intrahepatic portosystemic shunt placement, should be reserved for patients developing acute PVT before or after liver transplantation, or in alternative to thrombolysis when anticoagulation fails.
Malformación cavernomatosa de la vena porta
Common radiological findings are the thinning of the intestinal wall and the presence of defects of enhancement after intravenous contrast injection[ 8 ]. Finally, cavernooma surgery distal splenorenal shunt or Rex shunt, in children might be applied as the last choice, and only in absence of splenic or superior mesenteric vein thrombosis[ ].
Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. If thrombosis is recent and there is no underlying thrombophilic condition, anticoagulation should be administered for mo, as a complete portal vein recanalization can occasionally be delayed[ 79,- ].
Kocher G, Himmelmann A. Instead, a rapid and complete obstruction of the portal or mesenteric vein, without the involvement of the mesenteric venous arches, induces only intestinal congestion; the main feature is a diffuse thickening of the intestinal wall, visible even without alterations in contrast enhancement.
Extrahepatic portal vein thrombosis.
Cirrhosis Preserved liver function with precipitating factors splenectomy, surgical portosystemic shunting, TIPS dysfunction, thrombophilia Advanced disease in the absence of obvious precipitating factors. In non-cirrhotic and non-neoplastic patients, PVT has generally good outcome; exitus for gastrointestinal bleeding is uncommon[ 659697 ].
Etiology of portal vein thrombosis in adults. Thrombolytic treatment of portal thrombosis. Occasionally, it is not possible to recognize any overt cause of PVT; generally, the clinical course is favorable for these patients, with a low incidence of complications. If the obstruction is not resolved quickly, intestinal perforation, peritonitis, shock, and death from multiorgan failure might occur[ 8 ].
Intestinal congestion and ischemia, with abdominal pain, diarrhea, rectal bleeding, abdominal distention, nausea, vomiting, anorexia, fever, lactacidosis, sepsis, and splenomegaly are common features of acute PVT. Portal vein grafts in hepatic transplantation. However, the mechanism of PVT development is complex and multifactorial, and is not always attributable to a single cavrnoma factor.
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Extrahepatic portal vein thrombosis: J Am Coll Surg. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Med Sci. Thus, PVT seems more frequent than expected: Hereditary thrombophilia as a cause of Budd-Chiari syndrome: In addition, when intestinal infarction occurs, anticoagulants administered prior to laparotomy seem to have a consistent benefit on survival[ – ].
Journal List World J Gastroenterol v. On the other hand, chronic PVT can be nearly asymptomatic, except for the presence of varices, cutaneous collaterals, or ascites[ 62 ]. It has been demonstrated in rats, that the progressive obliteration of the portal vein stimulates apoptosis of hepatocytes in the hypoperfused lobe[ 10 ], while increasing the mitotic activity in the normal perfused one.