Kratkotrajno konzervativno lečenje bolesnika sa trombozom vene porte bez maligniteta i ciroze

  • Jelena Bošković Sekulić University Clinical Center Kragujevac, Center for Urgent Medicine, Kragujevac, Serbia
  • Igor Sekulić Military Medical Academy, Institute for Radiology, Belgrade, Serbia
  • Nemanja Rančić Military Medical Academy, Institute for Radiology, Belgrade, Serbia
  • Mina Stanić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Miloš Jovićević Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
  • Nenad Perišić Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP210731084B
Ključne reči: dijagnoza, diferencijalna, dijagnostičke tehnike i procedure, heparin, niskomolekulski, jetra, lečenje, ishod, tromboza, venska

Sažetak


Uvod. Tromboza vene porte (TVP) je delimična ili potpuna opstrukcija protoka krvi, nastala kao rezultat prisustva trombne mase u lumenu portalne vene (PV). U akutnoj fazi, simptomi kao što su bol u desnom gornjem kvadrantu, mučnina i groznica, nespecifični su. Raznolikost subakutnih i hroničnih simptoma povezana je sa komplikacijama vezanim za TVP i portalnu hipertenziju. Prikaz bolesnika.  Žena starosti 50 godina, primljena je u bolnicu zbog akutnih bolova u stomaku u vidu grčeva. Bol je trajao od 15 do 20 min, nakon čega je usledila defekacija normalne stolice i hematohezija u tri navrata. Bol u stomaku se ponovio kroz nekoliko sati, nakon čega su ponovo usledili hematohezija i tenezmi, svakih 10 min. Nakon prijema, urađena je kolonoskopija pomoću koje je otkrivena vulnerabilna, eritematozna sluznica debelog creva, sa kontaktnim krvarenjem u dužini od lijenalne fleksure do rektosigmoidnog prelaza. Tokom kolonoskopije urađena je i biopsija. Primenom kompjuterizovane tomografije (KT) otkrivena je parcijalna TVP, tromboza intrahepatičnih grana PV i tromboza donje mezenterične vene. Nakon konzervativnog lečenja niskomolekularnim heparinom (NMH) i drugom suportivnom terapijom, krvarenje u digestivnom traktu je prestalo, a defekacija je postala normalna. Tokom mesec dana praćenja, bolesnica nije imala komplikacija, a kontrolni pregled KT pokazao je normalan protok kroz PV, bez tromboze. Zaključak. Iako je retka, TVP kod bolesnika bez maligniteta i ciroze ne treba da se zanemari u diferencijalnoj dijagnozi, jer pravovremena i adekvatna terapija NMH može dovesti do potpunog izlečenja, bez teških komplikacija.

Reference

1.      Bayraktar Y, Harmanci O. Etiology and consequences of thrombosis in abdominal vessels. World J Gastroenterol 2006; 12(8): 1165‒74.

2.      Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol. 2010; 8(2): 200–5.

3.      Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol 2002; 97(3): 535‒41.

4.      Pieri G, Theocharidou E, Burroughs AK. Liver in haematological disorders. Best Pract Res Clin Gastroenterol 2013; 27(4): 513‒30.

5.      Riva N, Donadini MP, Dentali F, Squizzato A, Ageno W. Clinical approach to splanchnic vein thrombosis: risk factors and treatment. Thromb Res 2012; 130(Suppl 1): S1‒S3.

6.      Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95(10): 1245‒51.

7.      Seijo S, Plessier A. Noncirrhotic nontumoral portal vein thrombosis. Clin Liver Dis (Hoboken) 2014; 3(6): 118‒21.

8.      Llop E, Seijo S. Treatment of non-cirrhotic, non-tumoural portal vein thrombosis. Gastroenterol Hepatol 2016; 39(6): 403‒10. (Spanish)

9.      Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol 2006; 3(9): 505‒15.

10.   Kocher G, Himmelmann A. Portal vein thrombosis (PVT): a study of 20 non-cirrhotic cases. Swiss Med Wkly 2005; 135(25‒26): 372‒6.

11.   Kumar A, Sharma P, Arora A. Portal vein obstruction-epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharmacol Ther 2015; 41(3): 276‒92.

12.   Trebicka J, Strassburg CP. Etiology and Complications of Portal Vein Thrombosis. Viszeralmedizin 2014; 30(6): 375‒80.

13.   Malone PC, Agutter, PS. The Aetiology of Deep Venous Thrombosis: A Critical, Historical and Epistemological Survey. Paris: Springer; 2008.

14.   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): 143‒55.

15.   Wang JT, Zhao HY, Liu YL. Portal vein thrombosis. Hepatobiliary Pancreat Dis Int 2005; 4(4): 515‒8.

16.   Denninger MH, Chaït Y, Casadevall N, Hillaire S, Guillin MC, Bezeaud A, et al. Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000; 31(3): 587‒91.

17.   Webster GJ, Burroughs AK, Riordan SM. Review article: portal vein thrombosis -- new insights into aetiology and management. Aliment Pharmacol Ther 2005; 21(1): 1‒9.

18.   DeLeve LD, Valla DC, Garcia-Tsao G, American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49(5): 1729‒64.

19.   Van Gansbeke D, Avni EF, Delcour C, Engelholm L, Struyven J. Sonographic features of portal vein thrombosis. AJR Am J Roentgenol 1985; 144(4): 749‒52.

20.   Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 3rd ed. Philadelphia: Saunders; 2007.

21.   Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am 1997; 77(2): 327‒38.

22.   Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51(1): 210‒8.

23.   European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Vascular diseases of the liver. J Hepatol 2016; 64(1): 179‒202.

24.   Lopera JE, Correa G, Brazzini A, Ustunsoz B, Patel S, Janchai A, et al. Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis. J Vasc Surg 2002; 36(5): 1058‒61.

25.   Aytekin C, Boyvat F, Kurt A, Yologlu Z, Coskun M. Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis. Eur J Radiol 2001; 39(2): 80‒2.

26.   Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16(5): 651‒61.

27.   Kercher KW, Sing RF, Watson KW, Matthews BD, LeQuire MH, Heniford BT. Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 2002; 12(2): 131‒6.

28.   Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol 2015; 5(1): 22‒40.

29.   Klinger C, Riecken B, Schmidt A, De Gottardi A, Meier B, Bosch J, Caca K. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49(12): 1345‒52.

30.   Mammen S, Keshava SN, Kattiparambil S. Acute Portal Vein Thrombosis, No Longer a Contraindication for Transjugular Intrahepatic Porto-Systemic Shunt (TIPS) Insertion. J Clin Exp Hepatol 2015; 5(3): 259‒61.

31.   Sharma AK, Kaufman DC. TIPS performed in a patient with complete portal vein thrombosis. Radiol Case Rep 2017; 12(2): 327‒30.

Objavljeno
2023/08/01
Broj časopisa
Vol. 80 Br. 07 (2023): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika