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Case Reports
. 2025 Jan 31;104(5):e41238.
doi: 10.1097/MD.0000000000041238.

Portal vein thrombosis complicating neonatal umbilical vein catheterization in a 3-month-old infant with coincidental extrahepatic biliary atresia: A case report

Mortada H F El-Shabrawi  1 , Ayman Hussein Abdel Sattar  2 , Fetouh Hassanin  3 , Maha Fathy Sheba  1 , Ahmed Elhennawy  4 , Naglaa M Kamal  1 , Mohammed A M Oshi  5 , Ali Algarni  6 , Seham Anwar Emam Marzouk  7
Affiliations
Case Reports

Portal vein thrombosis complicating neonatal umbilical vein catheterization in a 3-month-old infant with coincidental extrahepatic biliary atresia: A case report

Mortada H F El-Shabrawi et al. Medicine (Baltimore). .

Abstract

Rationale: Umbilical vein catheterization (UVC) is a common procedure in neonatal intensive care units (NICU) but carries risks of severe complications such as portal vein thrombosis (PVT). Extrahepatic biliary atresia (EHBA), a leading cause of neonatal cholestasis, often progresses to end-stage liver disease. This case report discusses the rare coexistence of PVT and EHBA in a 3-month-old infant, highlighting the critical need for timely diagnosis and intervention.

Patient concerns: A 3-month-old female presented with jaundice, dark-colored urine, and clay-colored stools. She had a history of NICU admission for neonatal sepsis during which a UVC was inserted.

Diagnoses: Physical examination revealed jaundice and hepatosplenomegaly. Abdominal ultrasonography identified hepatosplenomegaly, mild ascites, and portal cavernoma. A liver biopsy confirmed a diagnosis of EHBA.

Interventions: The patient underwent Kasai portoenterostomy. Postoperatively, she developed complications including ascites, systemic hypertension, and hyperammonemia. Initial improvements were observed with decreased bilirubin levels.

Outcomes: Despite initial stabilization, the patient's condition deteriorated, and she succumbed on day 15 postoperation.

Lessons: This case underscores the significant risks of PVT associated with UVC and the importance of monitoring NICU graduates for early detection of complications. The early onset of portal hypertension and esophageal varices in this case challenges existing beliefs about EHBA's clinical progression. Greater awareness and routine follow-up imaging are essential to improve outcomes in similar scenarios.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Color Doppler ultrasound scan showing portal cavernoma.
Figure 2.
Figure 2.
Needle liver biopsy showing distorted architecture, expanded portal areas with fibrous septa formation (Gomori trichrome, original magnification ×40).
Figure 3.
Figure 3.
Intraoperative photo showing early cirrhotic liver and several peri-portal vein collaterals at the porta hepatis with a fibrotic main trunk (portal cavernoma).
See this image and copyright information in PMC

References

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