A giant portal vein thrombosis as a complication of cryotherapy

Year 2018, Volume: 3 Issue: 1-2, 1 - 5, 04.04.2019

Tolga Şahin , Ayfer Serin Nagihan İnan Gürcan Birkan Bozkurt Ertan Emek Yaman Tokat

https://izlik.org/JA24PD44JM

Abstract

Portal vein thrombosis (PVT) is frequently observed as a complication of certain malignant or benign conditions. In this article, we report a 42-year-old male patient with no history of previous illness who applied to our emergency department due to severe abdominal pain in all four quadrants. One week prior to the incident, the patient had started whole-body cryotherapy as a remedy for shoulder pain. Routine and detailed etiology-oriented laboratory tests showed no abnormalities. The patient was diagnosed with acute PVT based on abdominal computed tomography (CT) scan findings. The patient was started on intravenous heparin infusion, after which the state of thrombosis was reassessed with follow-up CT scans. When the thrombus receded, oral intake was started. The patient was followed-up for several days and discharged with instructions for the use of low-molecular-weight heparin. Portal vein thrombosis may be an acute complication of whole-body cryotherapy, as discussed in this case.

Keywords

Abdominal pain , portal vein thrombosis , shoulder pain , whole-body cryotherapy

References

• 1. Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol 2006;3:505-15. 2. Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol 2004;40:736-41. 3. Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006;12:2115-9. 4. Parikh S, Shah R, Kapoor P. Portal vein thrombosis. Am J Med 2010;123:111-9. 5. Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N, et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology 1985;89:279-86. 6. Stanek A, Cholewka A, Wielkoszynski T, Romuk E, Sieron A. Whole-Body Cryotherapy Decreases the Levels of Inflammatory, Oxidative Stress, and Atherosclerosis Plaque Markers in Male Patients with Active-Phase Ankylosing Spondylitis in the Absence of Classical Cardiovascular Risk Factors. Mediators Inflamm 2018;2018:8592532 7. Straub A, Krajewski S, Hohmann JD, Westein E, Jia F, Bassler N, et al. Evidence of platelet activation at medically used hypothermia and mechanistic data indicating ADP as a key mediator and therapeutic target. Arterioscler Thromb Vasc Biol 2011;31:1607-16. 8. Rosillo SO, Lopez-de-Sa E, Iniesta AM, de Torres F, del Prado S, Rey JR, et al. Is therapeutic hypothermia a risk factor for stent thrombosis? J Am Coll Cardiol 2014;63:939-40. 9. de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010;53:762-8. 10. Rajani R, Björnsson E, Bergquist A, Danielsson A, Gustavsson A, Grip O, et al. The epidemiology and clinical features of portal vein thrombosis: a multicentre study. Aliment Pharmacol Ther 2010;32:1154-62. 11. Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010;51:210-8. 12. Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, et al. Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology 2001;120:490-7. 13. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349:146-53. 14. Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE. Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol 2010;8:200-5. 15. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510. 16. Haas CE, Nelsen JL, Raghavendran K, Mihalko W, Beres J, Ma Q, et al. Pharmacokinetics and pharmacodynamics of enoxaparin in multiple trauma patients. J Trauma 2005;59:1336-43. 17. Sharma AM, Zhu D, Henry Z. Portal vein thrombosis: When to treat and how? Vasc Med 2016;21:61-9.