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.