Crohn disease - portal vein thrombosis

Case contributed by Dr Bruno Di Muzio

Presentation

Abdominal distention, pain, and vomiting. Known history of Crohn disease. ?perforation ? obstruction

Patient Data

Age: 24-year-old
Gender: Male

Abdomen

Modality: X-ray

 

Supine and erect projections. There is a focal prominent small bowel loop dilation and air-fluid levels in keeping with bowel obstruction. The colonic gas distribution appear unremarkable. Signs of ascites. 

 

Abdomen and pelvis

Modality: CT

 

There is a long segment of small bowel distention associated with wall thickening and mucosa enhancement, and no clear mechanical factor for the obstruction. The transition to normal bowel calibre is observed in the right iliac fossa. Proximal small bowel is mildly distended. The colon is unremarkable. No free gas to indicate perforation.

Multiple enlarged mesenteric lymph nodes, measuring up to 12 mm in short axis.

Extensive portal vein thrombosis from the vein formation to some middle sized intrahepatic ramifications in both lobes. Liver parenchyma is normal in appearance. Distended gallbladder. Multiple cysts in the spleen. The pancreas, kidneys and adrenal glands are normal.

Great volume of ascites. Bilateral pleural effusions associated with restrictive atelectasis within the lower pulmonary lobes.

Case Discussion

This case reflects the already known risk of venous thromboembolism in patients with inflammatory bowel diseases such as Crohn disease, however, portal vein thrombosis is a rare complication that usually occurs in the setting of recent bowel resection surgery. This patient was submitted to partial right colon and distal ileum resection one year and a half ago. 

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Case Information

rID: 44167
Case created: 9th Apr 2016
Last edited: 5th Aug 2016
Inclusion in quiz mode: Included

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