Portal vein thrombosis (PVT) is caused by several conditions including infection, malignancies, surgery, medications, and coagulation disorders. However, PVT caused by low-energy injury is very rare. A 51-year-old man visited a clinic with a 2-day history of abdominal pain following blunt abdominal trauma. Contrast-enhanced computed tomography (CT) revealed thrombosis in both the portal vein and splenic vein, and he was transferred to our hospital with a diagnosis of PVT. Anticoagulant therapy was initiated using unfractionated heparin. A repeat CT scan revealed enlargement of the thrombus, which occluded the main trunk and first right branch of the portal vein. Laboratory data before heparin administration suggested low protein C activity. Anticoagulation therapy was continued with intermittent assessment of the size of the thrombus and degree of coagulation. On day 23, enhanced CT showed marked shrinkage of the thrombus compared with that on day 8. On day 30, the patient was discharged with a therapeutic prothrombin time–international normalized ratio. Here we present a case of PVT caused by low-energy trauma of the upper abdomen in a patient with a background of low protein C activity that was successfully treated without invasive surgery.
Portal vein thrombosis Low-energy injury Low protein C activity
This is a preview of subscription content, log in to check access.
The authors declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).
The patient provided consent for the publication of his images.
Kocher G, Himmelmann A. Portal vein thrombosis (PVT): a study of 20 non-cirrhotic cases. Swiss Med Wkly. 2005;135:372–6.PubMedGoogle Scholar
Ogren M, Bergqvist D, Björck M, et al. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006;12:2115–9.CrossRefGoogle Scholar
Wang JT, Zhao HY, Liu YL. Portal vein thrombosis. Hepatobiliary Pancreat Dis Int. 2005;4:515–8.PubMedGoogle Scholar
Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med. 2007;22:1453–8.CrossRefGoogle Scholar
Valla DC. Portal vein thrombosis in adult: pathophysiology, pathogenesis and management. J Hepatol. 2000;32:865–71.CrossRefGoogle Scholar
Yonemitsu Y, Yanaga K, Matsumata T, et al. Portal vein thrombosis due to antithrombin III deficiency. A case report. Angiology 1995;46:1043–7.CrossRefGoogle Scholar
Duvoux C, Radier C, Gouault-Heilmann M, et al. A rare cause of portal vein thrombosis: closed abdominal trauma. Gastroenterol Clin Biol. 1994;18:165–7.CrossRefGoogle Scholar
Kim Y, Hamaji M, Ochi A, et al. A case of superior mesenteric thrombosis following contusion to the abdomen. J Abdom Emerg Med. 1995;15:822.Google Scholar
Beaufort P, Perney P, Coste F, et al. Post traumatic thrombosis of the portal vein. Presse Med. 1996;25:247–8.PubMedGoogle Scholar
Fried M, Van Ganse W, Van Avermaet S. Mesenteric vein thrombosis triggered by blunt abdominal trauma in a patient with the primary antiphospholipid syndrome. Eur J Gastroenterol Hepatol. 2002;14:697–700.CrossRefGoogle Scholar
Gonzalez F, Condat B, Deltenre P, et al. Extensive portal vein thrombosis related to abdominal trauma. Gastroenterol Clin Biol. 2006;30:314–6.CrossRefGoogle Scholar
van Riessen S, Wasowicz Kemps DK, Besselink MGH, et al. Massive portal vein thrombosis and kidney rupture following blunt abdominal trauma: a diagnostic and therapeutic dilemma. Inj Extra. 2008;39:71–5.CrossRefGoogle Scholar
Rastogi R, Bhargava SK, Bhatt S, et al. Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen. J Indian Assoc Pediatr Surg. 2008;13:72–4.CrossRefGoogle Scholar
Gopal SV, Smith I, Malka V. Acute portal venous thrombosis after blunt abdominal trauma. Am J Emerg Med 27:372.e1–3, 2009.CrossRefGoogle Scholar
Augusto I, Cezar A, NASR A, et al. Mesenteric thrombosis in patient victim of blunt abdominal trauma with fatal outcome. Arq Bras Cir Dig. 2010;23:58–60.CrossRefGoogle Scholar
Sood D, Kumaran V, Soin AS, et al. Blunt abdominal trauma, acute mesenteric venous thrombosis and small bowel stricture. Trop Gastroenterol. 2010;31:223–5.PubMedGoogle Scholar
Noguchi W, Uchida T, Takeuchi A, et al. A case of multiple digestive tract damage accompanied with superior mesenteric vein thrombosis following seat belt compression. KANTO J Jpn Assoc Acute Med. 2010;31:20–1.Google Scholar
Omoto K, Sekiya H, Uemura Y, et al. A case of superior mesenteric vein thrombosis following blunt abdominal trauma. J Jpn Assoc Surg Trauma. 2015;29:394–8 (in Japanese).Google Scholar
Maeda S, Takahashi M, Sato S, et al. A case of superior mesenteric vein thrombosis caused by protein C deficiency treated with anticoagulants. J Jpn Surg Assoc. 2015;76:1607–15 (in Japanese).Google Scholar
Negishi H, Kobayashi S, Mori S, et al. A case of mesenteric vein thrombosis caused by protein C and S deficiency. J Abdom Emerg Med. 2013;33:611–4 (in Japanese).Google Scholar
Momoi A, Komura Y, Kumon I, et al. Mesenteric venous thrombosis in hereditary protein C deficiency with the mutation at Arg169 (CGG → TGG). Intern Med. 2003;42:110–6.CrossRefGoogle Scholar
Rodrıguez-Leal GA, Moran S, Corona-Cedillo R, et al. Portal vein thrombosis with protein C–S deficiency in a non-cirrhotic patient. World J Hepatol. 2014;6:532–7.CrossRefGoogle Scholar
Ponziani FR, Zocco MA, Campanale C, et al. Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 2010;16:143–55.CrossRefGoogle Scholar
Orozco H, Guraieb E, Takahashi T, et al. Deficiency of protein C in patients with portal vein thrombosis. Hepatology. 1988;8:1110–1.CrossRefGoogle Scholar
Aiach M, Borgel D, Gaussem P, Emmerich J, et al. Protein C and protein S deficiencies. Semin Hematol. 1997;34:205–16.PubMedGoogle Scholar
European Association for the Study of the Liver. EASL clinical practice guidelines: vascular diseases of the liver. J Hepatol 2016;64:179–202.CrossRefGoogle Scholar
Sharma VK, Ranade PR, Marar S, et al. Portal vein thrombosis: when to treat and how? Vasc Med. 2016;21:61–9.CrossRefGoogle Scholar
Grisham A, Lohr J, Guenther JM, et al. Deciphering mesenteric venous thrombosis: imaging and treatment. Vasc Endovasc Surg. 2005;39:473–9.CrossRefGoogle Scholar
Thomas RM, Ahmad SA. Management of acute post-operative portal venous thrombosis. J Gastrointest Surg. 2010;14:570–7.CrossRefGoogle Scholar
Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003;388:141–9.CrossRefGoogle Scholar
Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med. 2001;345:1683–8.CrossRefGoogle Scholar