Portal, superior mesenteric and splenic vein thrombosis secondary to hyperhomocysteinemia with pernicious anemia: a case report

Journal of Medical Case Reports

Bakr Nour³  Vajjala R Kumar⁴  Mohammad F Malmstrom²  Nissar Shaikh²  Prashanth Venkatesh¹ 

[1]Weill Cornell Medical College in Qatar, Ar-Rayyan, Qatar

[2]Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar

[3]Department of Surgery, Hamad Medical Corporation, Doha, Qatar

[4]Department of Radiology, Hamad Medical Corporation, Doha, Qatar

关键词: Thrombophilia markers;    Portal vein thrombosis;    Pernicious anemia;    Laparotomy;    Hyperhomocysteinemia;   

Others  :  1181066
DOI  :  10.1186/1752-1947-8-286

 received in 2014-02-24, accepted in 2014-06-26,  发布年份 2014

【 摘 要 】

Introduction

Acute portomesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small-bowel gangrene and end-stage hepatic failure. It is known to be caused by various pro-thrombotic states, including hyperhomocysteinemia. We describe what is, to the best of our knowledge, the first reported case of concomitant thrombosis of portal, superior mesenteric and splenic veins due to hyperhomocysteinemia secondary to pernicious anemia and no other risk factors.

Case presentation

A 60-year-old Indian man presented with epigastric pain, diarrhea and vomiting. An abdominal imaging scan showed that he had concomitant pernicious anemia and concomitant portal, superior mesenteric and splenic vein thrombosis. A work-up for the patient’s hypercoagulable state revealed hyperhomocysteinemia, an undetectable vitamin B₁₂ level and pernicious anemia with no other thrombophilic state. He developed infarction with perforation of the small bowel and subsequent septic shock with multi-organ dysfunction syndrome, and he ultimately died due to progressive hepatic failure.

Conclusion

This report demonstrates that pernicious anemia, on its own, can lead to hyperhomocysteinemia significant enough to lead to lethal multiple splanchnic vein thrombosis. Our case also underscores the need to (1) consider portomesenteric thrombosis in the differential diagnosis of epigastric abdominal pain, (2) perform a complete thrombotic work-up to elucidate metabolic abnormalities that could be contributing to a pro-thrombotic state and (3) initiate aggressive measures, including early consideration of multi-visceral transplantation, in order to avoid decompensation and a significant adverse outcome.

【 授权许可】

   
2014 Venkatesh et al.; licensee BioMed Central Ltd.

【 图 表 】

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