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• W2977756711 abstract "Introduction: Although uncommon, inflammatory bowel disease (IBD) has been found to be an independent risk factor for acquired thrombosis, even rarer is portal vein thrombosis (PVT) as the presenting illness. Case Report: A 28 y/o nonsmoking female presented with 10 days of worsening abdominal pain. In addition, she reported nausea, vomiting, and bloody stools. On PE, she was alert, oriented, afebrile, mild tachycardia, normal blood pressure and generalized abdominal tenderness on deep palpation only. Routine labs indicated mild anemia, normal WBC and platelets, INR of 2.3 and elevated transaminases. Infectious stool evaluation did not reveal C. difficile, Salmonella, Shigella, Campylobacter, E. coli, or Ova/parasitic infection. However, stool showed increased Lactoferrin. Abdominal imaging revealed acute PVT on RUQ ultrasound with Doppler and CT abdomen/pelvis suggested colitis. Hypercoagulable state assessment did not confirm Lupus anticoagulant, Factor V Leiden or prothrombin abnormalities. Colonoscopy revealed hemorrhagic, inflamed and ulcerated mucosa from the rectum to transverse colon; biopsies displayed an interstitial neutrophilic/lymphoplasmocytic infiltrate with surface ulceration, cryptitis and crypt abscesses. She was treated simultanously with intravenous methylprednisolone q8 hours and enoxaparin BID for colitis and PVT, respectively. Patient responded well to treatment, eventually transitioning to oral prednisone and mesalamine as well as warfarin with resolution of all presenting symptoms. Discussion: Fewer than 10% of IBD patients have an extra intestinal manifestation at initial presentation. These are most commonly sacroilitis, peripheral arthritis, ocular, mucocutaneous and vascular. In one study, thromboembolic complications occurred in 1.3% of IBD patients with majority having deep vein thrombosis or pulmonary embolism. In IBD patients, inpatient status and steroid therapy as well as post bowel resection are risk factors for development of porto-mesenteric venous thrombosis. However, acute PVT has not been reported as part of an IBD initial presentation previously. Conclusion: PVT is very uncommon in patients with IBD, especially at presentation. If present, complete evaluation (including hypercoagulable state assessment, medication history review, smoking status and imaging) should occur. Therapeutic options including anticoagulation or thrombolysis can be used while simultaneously treating the IBD episode.Figure 1Figure 2Figure 3" @default.
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• W2977756711 date "2015-10-01" @default.
• W2977756711 modified "2023-09-27" @default.
• W2977756711 title "Portal Vein Thrombosis as Initial Manifestation of Ulcerative Colitis" @default.
• W2977756711 doi "https://doi.org/10.14309/00000434-201510001-00694" @default.
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