Zhang SB, Hu ZX, Xing ZQ, Li A, Zhou XB, Liu JH. Portal vein thrombosis in a noncirrhotic patient after hemihepatectomy: A case report and review of literature. World J Clin Cases 2022; 10(20): 7130-7137 [PMID: 36051122 DOI: 10.12998/wjcc.v10.i20.7130]
Corresponding Author of This Article
Jian-Hua Liu, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China. dr.ljh@outlook.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2022; 10(20): 7130-7137 Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7130
Portal vein thrombosis in a noncirrhotic patient after hemihepatectomy: A case report and review of literature
Shu-Bin Zhang, Zi-Xuan Hu, Zhong-Qiang Xing, Ang Li, Xin-Bo Zhou, Jian-Hua Liu
Shu-Bin Zhang, Zi-Xuan Hu, Zhong-Qiang Xing, Xin-Bo Zhou, Jian-Hua Liu, Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Ang Li, Department of Hepatobiliary Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Zhang SB, Li A, Liu JH, and Xing ZQ equally contributed to the patient’s management, and drafting and revising of the manuscript including literature search, figures, and references; Zhou XB, Zhang SB, and Hu ZX critically reviewed and revised the manuscript for important intellectual content; all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Hua Liu, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China. dr.ljh@outlook.com
Received: January 5, 2022 Peer-review started: January 5, 2022 First decision: February 21, 2022 Revised: March 6, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: July 16, 2022
Abstract
BACKGROUND
Portal vein thrombosis (PVT) is a condition caused by hemodynamic disorders. It may be noted in the portal vein system when there is an inflammatory stimulus in the abdominal cavity. However, PVT is rarely reported after hepatectomy. At present, related guidelines and major expert opinions tend to consider vitamin K antagonists or low-molecular weight heparin (LMWH) as the standard treatment. But based on research, direct oral anticoagulants may be more effective and safe for noncirrhotic PVT and are also beneficial by reducing the recurrence rate of PVT.
CASE SUMMARY
A 51-year-old woman without any history of disease felt discomfort in her right upper abdomen for 20 d, with worsening for 7 d. Contrast-enhanced computed tomography (CECT) of the upper abdomen showed right liver intrahepatic cholangiocarcinoma with multiple intrahepatic metastases but not to the left liver. Therefore, she underwent right hepatic and caudate lobectomy. One week after surgery, the patient underwent a CECT scan, due to nausea, vomiting, and abdominal distension. Thrombosis in the left branch and main trunk of the portal vein and near the confluence of the splenic vein was found. After using LMWH for 22 d, CECT showed no filling defect in the portal vein system.
CONCLUSION
Although PVT after hepatectomy is rare, it needs to be prevented during the perioperative period.
Core Tip: We present a case of portal vein thrombosis (PVT) after hemihepatectomy. It is most common in liver cirrhosis, postsplenectomy, and liver transplantation, but is relatively rare after hepatectomy. This case verified the safety and effectiveness of low-molecular weight heparin in this condition. In the perioperative period, attention should be given to the prevention, early diagnosis, and systemic treatment of PVT.
