SHM Converge Scientific Abstract ePoster Gallery-Acute Portal Vein Thrombosis in a Healthy Patient

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This case describes a 24-year-old man with recurrent pancreatitis who presented with three weeks of worsening abdominal pain, jaundice, rigors, nausea/vomiting, poor appetite, and dark urine. Exam showed abdominal tenderness and jaundice; labs revealed leukocytosis, conjugated hyperbilirubinemia, transaminitis, elevated alkaline phosphatase, and lipase. CT imaging suggested choledocholithiasis with biliary dilation, gallbladder inflammation, colonic wall thickening, and importantly bilateral portal venous thrombophlebitis with areas of hypoattenuation, consistent with acute portal vein thrombosis (PVT).<br /><br />He was treated initially with broad-spectrum antibiotics and IV fluids. Urgent ERCP showed no frank pus or obstruction, but biliary sphincterotomy with sludge clearance was performed, along with percutaneous cholecystostomy drain placement and pancreatic duct stenting. He was also started on a heparin drip. Four days later, he developed worsening hyperbilirubinemia and melena. Repeat ERCP identified bleeding at the sphincterotomy site, which was cauterized. He also had polymicrobial bacteremia and was discharged on oral levofloxacin and metronidazole.<br /><br />His liver tests improved, and anticoagulation was stopped after three months when follow-up confirmed resolution of the portal venous clot. The authors note that PVT without cirrhosis is uncommon and may be caused by inherited thrombophilia or acquired factors such as surgery, inflammatory bowel disease, trauma, or abdominal infection. In this patient, pancreatitis/cholangitis likely contributed through local inflammation, venous compression, and a prothrombotic state.<br /><br />The key lesson is that persistent or worsening symptoms despite standard treatment should prompt further evaluation for hidden complications like portal vein thrombosis, especially in severe abdominal infections.

Asset Subtitle

Monica Singh

Meta Tag

Author List Ethan Molitch-Hou, Monica Singh, Nhi Lam

Category Clinical Vignettes

Concept Portal Vein Thrombosis

Concept Non-Cirrhotic Portal Vein Thrombosis

Concept Portal Vein Thrombophlebitis

Concept Anticoagulation

Concept Bleeding Risk

Distinguished Non-Finalist

Presenter Organization University of Chicago Medical Center

Presenting Author Monica Singh

Track Adult

Keywords

portal vein thrombosis

acute pancreatitis

choledocholithiasis

cholangitis

biliary obstruction

ERCP

heparin anticoagulation

polymicrobial bacteremia

portal venous thrombophlebitis

gallbladder inflammation

Portal Vein Thrombosis

Non-Cirrhotic Portal Vein Thrombosis

Portal Vein Thrombophlebitis

Anticoagulation

Bleeding Risk