A Rare Postoperative Complication of Acute Appendicitis: Portal Vein Thrombosis Required Small Intestine Resection

Year 2023, Volume: 13 Issue: 4, 128 - 131, 27.12.2023

Tolga Kalaycı

https://doi.org/10.33706/jemcr.1141241

Abstract

This case report aims to present the diagnosis and treatment process of portal vein thrombosis, which occurred one week after laparoscopic appendectomy and required small bowel resection. A thirty-eight-year-old man was admitted with abdominal pain in the periumbilical and epigastric regions. He had a history of appendectomy and occlusive cerebrovascular disease. In the physical examination of the abdomen, tenderness was detected in the epigastric region on deep palpation. Leucocytosis, increased levels of alanine transaminase level, aspartate transaminase, gamma-glutamyl transferase, lactate dehydrogenase, c-reactive protein, and d-dimer were detected in laboratory analyses. CT scan revealed total thrombus in the portal vein, oedema in the segment of approximately 10 cm in the distal ileum, and free fluid in the pelvic region. Enoxaparin sodium was started. During follow-up, widespread defence and rebound in all quadrants of the abdomen occurred. 20 cm ileal resection with end ileostomy was performed. Enoxaparin sodium treatment was continued. On the 6th day of the service follow-up, the patient had left leg pain, and a subacute thrombus was detected in the main femoral, superficial femoral and deep femoral veins on doppler USG. Edoxaban tosylate 60 mg tablet every 24 hours started as an anti-coagulant treatment, and the patient was discharged without complications on the 18th day of hospitalisation.

Keywords

Appendectomies, enoxaparine, portal vein, thromboses.

References

• Kalayci T. Flank abscess after perforated acute appendicitis. Anatolian J Emerg Med. 2021;4(3):106-9.
• Sulu B, Demir E, Günerhan Y. Genç hastada appendektomi sonrası tekrarlayan karın ağrısının nadir bir nedeni: Portal ven trombozu. Turkish J Surg. 2012;28(1):042-5.
• Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H. Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol. 2007;7(1):1-6.
• Bayraktar Y, Harmanci O. Etiology and consequences of thrombosis in abdominal vessels. World J Gastroenterol. 2006;12(8):1165.
• Chawla Y, Duseja A, Dhiman RK. The modern management of portal vein thrombosis. Alimentary Pharmacology Therapeutics. 2009;30(9):881-94.
• Kocher G, Himmelmann A. Portal vein thrombosis (PVT): a study of 20 non-cirrhotic cases. Swiss Med Weekly. 2005;135(2526).
• Özkan U, Oguzkurt L, Tercan F, Tokmak N. Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol. 2006;12(2):105.
• Ferguson JL, Hennion DR. Portal vein thrombosis: an unexpected finding in a 28-year-old male with abdominal pain. J Am Board Family Med. 2008;21(3):237-43.
• Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nature Clin Prac Gastroenterol Hepatol. 2006;3(9):505-15.
• Uysal E, Çevik E, Çınar O, Acar YA, Mustafa G, Arslan D. Rare cause of abdominal pain at emergency department: portal vein thrombosis. J Emerg Med Case Rep. 2011;2(3):17-9.
• Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, et al. Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 2010;16(2):143.
• Cagin YF, Atayan Y, Erdogan MA, Dagtekin F, Colak C. Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients. Hepatobiliary Pancreatic Dis Int. 2016;15(5):499-503.
• Vanamo K, Kiekara O. Pylephlebitis after appendicitis in a child. J Pediatric Surg. 2001;36(10):1574-6.
• Akıncı O, Ferahman S, Ergün S, Kocael PÇ, Şimşek O, Kocael A. A Rare Complication After Laparoscopic Appendectomy: Superior Mesenteric Vein Thrombosis. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2018(1):79-82.