Portal Vein Thrombosis Extending to the Superior Mesenteric and Splenic Veins Secondary to a Hypercoagulable State Due to Prior Abdominal Surgery, Hormonal Replacement Therapy, and Flaxseed Consumption

Abstract

Herein is a case of a 50-year-old male diagnosed with a non-cirrhotic acute portal vein thrombosis (PVT). Acute PVT is a rare condition usually presenting in cirrhotic patients. This patient had no past medical history of cirrhosis or hypercoagulable status and no past family history of a hypercoagulable disorder. However, the patient, who has been on testosterone replacement therapy (TRT) along with over-the-counter flax seeds (commonly known to contain phytoestrogens), recently underwent an abdominal surgery essentially placing him in a hypercoagulable state which could contribute to the development of acute PVT. This case showed the importance of being aware of possible contributors to hypercoagulable states which can lead to the occurrence of these events.

Keywords: mesenteric venous thrombosis; portal vein thrombosis; surgery; testosterone; thrombosis.

Figure 1. Computerized tomography of the abdomen and pelvis with contrast shows an extensive clot seen in the portal, splenic, and superior mesenteric veins (yellow circle).

Figure 2. Computed tomography angiogram of the abdomen and pelvis confirms an extensive clot in the portal, splenic, and superior mesenteric veins (yellow circle).