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• W4387248614 abstract "SESSION TITLE: Vascular Complications in the ICU SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic condition with highly variable presentation. We present a case of a young male with acute on chronic portal venous thrombosis (PVT) and variceal bleeding due to APS. CASE PRESENTATION: A 32-year-old male smoker was transferred to our MICU due to epigastric discomfort, pancreatitis, and massive hematemesis with a hemoglobin drop from 12 to 8 grams/dL on octreotide and pantoprazole infusions. He was intubated on ventilator support. EGD revealed extensive esophageal varices and gastric varices with large stomach blood clots. He was transferred to our facility for Interventional radiology (IR) and gastroenterology (GI) evaluation. A CTA of the abdomen and pelvis revealed splenomegaly, portal hypertension, pancreatitis, and thrombosis of the splenic vein, superior mesenteric vein, and portal vein thrombosis. A repeat EGD revealed no active bleed and recommended splenic artery embolization, which was done by the IR team. The patient continued to have hematochezia and required multiple transfusions. He then underwent repeat splenic artery embolization with only 15% viable spleen. His bleeding did not stop, and vascular surgery and the IR team did not recommend TIPS due to extensive thrombosis. Acute care surgery agreed and mentioned that splenectomy would not benefit the patient. He continued to bleed and was started on a massive transfusion protocol. EGD was repeated, and five esophageal varices with red spots were banded. Clinical history review revealed noncompliance with anticoagulation for venous thrombosis and work up was positive for APS. Unfortunately, the bleeding continued, and due to a poor prognosis family opted for comfort care. DISCUSSION: PVT-precipitating portal hypertension, subsequent variceal bleeding, and liver dysfunction is a rare complication of fulminant APS. This constellation of sequelae carries a poor prognosis and is very challenging to treat [1]. Treatment options are limited and rely on preventing complications such as variceal bleeding by managing portal hypertension [2]. Anticoagulation for portal venous thrombosis during active variceal bleed is contraindicated despite variceal banding, and our patient was not a candidate for portosystemic shunt due to the extent of thrombosis [1]. This case highlights the importance of considering APS as an underlying etiology in critically ill patients with noncirrhotic portal hypertension. It also reinforces the importance of a multidisciplinary team approach in managing fulminant APS, especially given the lack of guideline-directed management and randomized controlled trials [3]. CONCLUSIONS: Portal vein thrombosis precipitating portal hypertension, subsequent variceal bleeding, and liver dysfunction is a rare but documented complicated presentation of fulminant APS. Treatment is challenging, complex, and there is a lack of literature regarding management guidelines. REFERENCE #1: Ogimoto A, Sekiya M, Funada J, Miyagawa M, Kubo Y, Akutsu H. Antiphospholipid syndrome with acute myocardial infarction and portal vein occlusion: a case report. Jpn Circ J. 2000;64(6):468-470. REFERENCE #2: Schouten JN, Verheij J, Seijo S. Idiopathic non-cirrhotic portal hypertension: a review. Orphanet Journal of Rare Diseases. 2015;10. REFERENCE #3: Gairing SJ, Kloeckner R, Pitton MB, et al. Multidisciplinary approach to the complex treatment for non-cirrhotic portal hypertension - case-report-based discussion. Z Gastroenterol. 2021;59(1):43-49. DISCLOSURES: No relevant relationships by Tyler Boyd No relevant relationships by SACHIN PATIL No relevant relationships by hafsa safdar" @default.
• W4387248614 created "2023-10-03" @default.
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• W4387248614 date "2023-10-01" @default.
• W4387248614 modified "2023-10-03" @default.
• W4387248614 title "LIVER CIRRHOSIS AND VARICEAL BLEEDING SECONDARY TO PORTAL VEIN THROMBOSIS IN A PATIENT WITH ANTIPHOSPHOLIPID SYNDROME: UNIQUE THERAPEUTIC AND PROGNOSTIC CONSIDERATIONS" @default.
• W4387248614 doi "https://doi.org/10.1016/j.chest.2023.07.1880" @default.
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