Portal vein thrombosis after laparoscopic appendectomy for acute appendicitis: A case report

Abstract

Rationale: Portal vein thrombosis (PVT) has a complex pathophysiologic pathway and may cause life-threatening clinical complications. Malignancies, hepatic cirrhosis, auto-immune disorders, previous splenectomy, and other causes of thrombocytosis (over 1,000,000/mL) are the most common causes of PVT. On the other hand, hematologic disorders and infectious processes in the abdominal cavity may cause PVT uncommonly. We present a case of PVT following acute appendicitis and laparoscopic appendectomy in this report.

Patient concerns: A 32-year-old male was admitted to our emergency room due to lower quadrant pain and vomiting. Acute appendicitis was diagnosed and after a routine laparoscopic appendectomy, the patient was discharged. The patient was admitted to the emergency room with nonspecific epigastric pain on postoperative day 30.

Diagnoses: Portal vein thrombosis was diagnosed by computed tomography. Hematologic investigations revealed a homozygous mutation of the methylene tetrahydrofolate 1298 gene.

Interventions: Immediate low-molecular-weight heparin administration was initiated. The gastrointestinal system council and interventional radiology team opted for a medical approach and converted the low-molecular-weight heparin to apixaban.

Outcomes: The computed tomography revealed the complete resolution of the thrombus on postoperative day 100.

Lessons: Laparoscopic appendectomy can be complicated by portomesenteric axis thrombosis. When unusual findings are encountered during the postoperative follow-up period, rapid and detailed examinations should be performed.

Keywords: acute appendicitis; case report; laparoscopy; portal vein; thrombosis.

Figure 1.

Computed tomography scans performed at the external center during the first emergency service admission of the patient, and intraoperative scene. The blind-ended and thickened-walled intestinal structure (white arrow). C = caecum, A = appendix.

Figure 2.

(A) The retrospective analysis of computed tomography (CT) scans performed at the external center during the first emergency service admission of the patient. (B) The CT scans of POD 30. (C) The CT scans of the POD 100.