Thrombosis of a portal vein

Description:

Thrombosis of a portal vein (pylethrombosis) — a rare disease, idiopathic option meets in 13-61% of all thromboses of a portal vein.

Reasons of thrombosis of a portal vein:

Thrombosis of a portal vein at newborns is usually connected with an infection of a stump of an umbilical cord which extends through a funic vein in a portal vein. Children of advanced age a source can have an acute appendicitis at which the infection gets to portal system, causing an inflammation of a portal vein (pylephlebitis) which can lead to thrombosis. The congenital anomalies of a portal vein causing her thrombosis are usually combined with other inborn defects. At adults surgical interventions (for example, a splenectomy), a hypercoagulative  syndrome  (for example, myeloproliferative disturbances, deficit of protein C or S), a malignant tumor (for example, a hepatocellular carcinoma or a pancreatic cancer), cirrhosis and pregnancy are the main reasons. The reason remains unspecified approximately in 50% of cases.

Symptoms of thrombosis of a portal vein:

Consider options of acute and chronic thrombosis of a portal vein.

Acute thrombosis is characterized by developing of severe pains in a stomach, a diarrhea, a hematemesis and the progressing falling of the ABP, up to a collapse. Quickly enough liver abscess can be created, in ascitic liquid there can be erythrocytes. If there is no cirrhosis, then the liver is not changed and, as a rule, jaundice does not develop. Quickly enough pains in left hypochondrium join, the intestines heart attack develops.

At chronic thrombosis developing of portal hypertensia, splenomegaly, varicosity of veins of a gullet, a hypersplenism, abscess of a liver, bleedings is possible. Distinctive feature of portal hypertensia in connection with thrombosis of a portal vein is lack of changes in the liver, long preservation of normal indicators of all its functional trials, i.e. a peculiar intact liver against the background of portal hypertensia. Such combination speaks well for chronic thrombosis of a portal vein.

Complications. At the initial stages gastrointestinal bleedings are possible. Later they become persistent, there are cases of ruptures of a spleen. Further intestines heart attacks accrue. The hepatic coma can develop.

Diagnosis:

Emergence and development of portal hypertensia, inadequately bystry for the available disease, is indicative. At acute and subacute thrombosis diameter of a vein can be increased more than 13 mm. At chronic thrombosis it can be normal, it is less and not to be defined. Increase in echogenicity of a gleam as result of fibrosis, a location of fragments of a blood-groove is characteristic at neokklyuziruyushchy thrombosis, existence of periportal collaterals at chronic portal thrombosis.

Reliable diagnostic method is the angiography. Also the laparoscopy is used.

Treatment of thrombosis of a portal vein:

In acute cases of thrombosis anticoagulating therapy sometimes prevents its distribution, but does not lead to a lysis of the existing blood clots. At newborns and children treatment is directed to elimination of the reason (for example, an omphalitis, appendicitis). In other cases therapy of portal hypertensia and bleeding from varicose veins is carried out. At bleedings endoscopic bandaging (cliping) of veins is usually used. Effectively intravenous administration of an oktreotid - a synthetic analog of somatostatin. Such therapy reduced number of operations of shunting (for example, mesocaval, splenorenalny) at which the problem of thrombosis and mortality remains during operation (from 5 to 50%). Presumably, b-blockers (in a combination with nitrates) can be so effective in respect of prevention of bleedings, as well as at portal hypertensia as a result of cirrhosis, but it demands additional observations.