Portal Hypertension of a Delayed Onset Following Liver Abscesses in a 12-Month-Old Infant: A Case Report and Review of the Literature

Abstract

We report a 12-month-old female infant who had a history of neonatal sepsis with liver micro-abscesses that resolved with intravenous antibiotics during neonatal period. During her neonatal admission period, no umbilical vein catheter was inserted. Also, she did not undergo any abdominal surgeries or had a postnatal history of necrotizing enterocolitis. However, the child developed upper gastrointestinal bleeding in form of hematemesis and melena secondary to esophageal varices at the age of 12 months with an extra-hepatic portal vein obstruction with cavernous transformation and portal hypertension subsequently. The child underwent a successful endoscopic injection sclerotherapy. She is now 20-month-old and has portal hypertension but otherwise asymptomatic. We are proposing the possibility of a delayed-onset portal hypertension as a complication of liver abscess and neonatal sepsis.

Keywords: Esophageal and gastric varices; Liver abscess; Neonatal sepsis; Portal hypertension; Venous thrombosis.

Fig. 1. Endoscopic view of grade II esophageal varices. An endoscopic view of the two esophageal varices, both of grade II, first one at 10 o'clock position, and second one was seen at 12 o'clock position.

Fig. 2. Endoscopic view of grade II esophageal varices. An endoscopic view of the second esophageal varices at 12 o'clock position which extends from the level of 15 cm to the gastroesophageal junction at the level of 21 cm.

Fig. 3. CT angiogram. (A) Contrast enhanced axial CT scan of the abdomen showing dilated tortious vessels at the porta-hepatis and peripancreatic areas (arrow), in keeping with cavernous transformation of portal vein caused by portal hypertension. (B) Non-enhanced axial CT scan of the abdomen showing hypertrophy of the caudate lobe (arrow). (C) Contrast enhanced coronal CT scan of the abdomen showing splenomegaly and (D) minimal ascites at the sub-hepatic region.

CT: computed tomography.