Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7130
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
Processing time: 180 Days and 12 Hours
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.
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.
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.