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Portal Vein Thrombosis

By

Whitney Jackson

, MD, University of Colorado School of Medicine

Last full review/revision Feb 2020| Content last modified Feb 2020
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Topic Resources

Portal vein thrombosis causes portal hypertension and consequent gastrointestinal bleeding from varices, usually in the lower esophagus or stomach. Diagnosis is based on ultrasonography. Treatment involves control of variceal bleeding (usually with endoscopic banding, IV octreotide, or both), prevention of recurrence using beta-blockers, and sometimes surgical shunts and thrombolysis for acute thrombosis.

Etiology of Portal Vein Thrombosis

Symptoms and Signs of Portal Vein Thrombosis

Diagnosis of Portal Vein Thrombosis

Portal vein thrombosis is suspected in patients with the following:

Doppler ultrasonography Doppler ultrasonography Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more Doppler ultrasonography is usually diagnostic, showing diminished or absent portal vein flow and sometimes the thrombus. Difficult cases may require MRI or CT with contrast. Angiography may be required to guide shunt surgery.

Treatment of Portal Vein Thrombosis

  • For some acute cases, thrombolysis

  • Long-term anticoagulation

  • Management of portal hypertension and its complications

In acute cases, thrombolysis is sometimes successful, best reserved for recent occlusion, particularly in hypercoagulable states. Anticoagulation does not lyse clots but has some value for long-term prevention in hypercoagulable states despite the risk of variceal bleeding Varices Varices are dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis. They may bleed massively but cause no... read more Varices . In neonates and children, treatment is directed at the cause (eg, omphalitis, appendicitis). Otherwise, management is directed at the portal hypertension Portal Hypertension Portal hypertension is elevated pressure in the portal vein. It is caused most often by cirrhosis (in developed countries), schistosomiasis (in endemic areas), or hepatic vascular abnormalities... read more and its complications; treatment can include octreotide IV (a synthetic analog of somatostatin) and endoscopic banding to control variceal bleeding and nonselective beta-blockers to prevent rebleeding. These therapies have decreased the use of surgical shunts (eg, mesocaval, splenorenal), which can become occluded and have an operative mortality rate of 5 to 50%. Transjugular intrahepatic portosytemic shunting (TIPS) has a limited role in the treatment of portal vein thrombosis Treatment Portal vein thrombosis causes portal hypertension and consequent gastrointestinal bleeding from varices, usually in the lower esophagus or stomach. Diagnosis is based on ultrasonography. Treatment... read more (see [1] Treatment reference Portal vein thrombosis causes portal hypertension and consequent gastrointestinal bleeding from varices, usually in the lower esophagus or stomach. Diagnosis is based on ultrasonography. Treatment... read more ).

Treatment reference

  • Valentin N, Korrapati P, Constantino J, et al: The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: A systematic review and meta-analysis. Eur J Gastroenterol Hepatol 30(10):1187-1193, 2018.

Key Points

  • Causes of and risk factors for portal vein thrombosis include umbilical cord infection (in neonates), appendicitis (in children), and hypercoagulability states (in adults).

  • Suspect portal vein thrombosis if patients have manifestations of portal hypertension in the absence of cirrhosis or if they have mild, nonspecific liver abnormalities plus risk factors.

  • Confirm the diagnosis using Doppler ultrasonography or, if results are inconclusive, MRI or CT with contrast.

  • Treat the cause of portal vein thrombosis and the complications of portal hypertension.

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