Portal vein thrombosis
Definition
The Portal vein thrombosis is a very rare kind of thrombosis. In autopsy reports you can find a frequency of 0.05% up to 0.5% of conditions that promote a pylethrombosis, such as infections and inflammation processes, or constrictions at the orifice of the portal vein caused by tumour or a disease that lowers the flow in the portal vein. In 24%- 36% of the cases a cirrhosis of the liver is the cause, even though the frequency of a Portal vein thrombosis when there is a cirrhosis of the liver is just 0.6% - 26 %. Malignant tumours, mostly in the liver or pancreas, and carcinomas are diagnosed in 21% to 24% of the cases of pylethrombosis. 10% to 25% of the cases of pylethrombosis are caused by infections with sepsis in the area of the liver or gall, but also in cases of amebic dysentery, acute necrotizing inflammation of the pancreas, diverticulitis or typhlitis. The mortality of acute pylethrombosis averages to 50%. The prognosis of a pylethrombosis that is not caused by a cirrhosis of the liver, a septic befall or a malignant tumour is good. The 10-year-survival rate then is 70%.
Clinical problems
A Portal vein thrombosis does not manifest itself with acute medical conditions. Because of unspecific medical conditions a pylethrombosis is usually not diagnosed. If the thrombosis expands to the intestine veins there will be strong abdominal pain because of the intestine infarction. Other symptoms are nausea, vomiting, diarrhea and weight reduction. Also there are sufferable temperatures sometimes. The values of the liver are usually normal or slightly increased.
Diagnosis
Diagnostic practices include the sonography, the colour-duplex-sonography, the computed tomography and the nuclear spin tomography. The sensitivity of the sonography and the colour-duplex-sonography is claimed to be around 83%- 94% and the computed sonography is supposed to have a sensitivity of 74%-100%.
Therapy
In the early stage anticoagulation with Heparin is performed with a following long lasting oral anticoagulation (Marcumar, Coumadin). In rare cases a fibrinolysis or a surgical thrombectomy is performed. There is no proof for the effect of the use of an anticoagulation or thrombological substances for patients with a chronic pylethrombosis and it is not recommended.