title: Portal vein thrombosis in the district general hospital: management and clinical outcomes.
abstract: BACKGROUND
  Portal vein thrombosis (PVT) refers to a thrombosis that occurs in the extrahepatic portal venous system in the presence or absence of underlying liver disease. The clinical presentation of PVT is extremely variable and there is no absolute consensus on its investigation and management. A paucity of literature examining this clinical entity in the district general hospital is observed.
  
  
  METHODS
  We reviewed the experience of two medium-sized district general hospitals in the UK. Twenty-five patients, who were diagnosed with PVT, were identified from the electronic databases of the two hospitals from 1994 to 2007.
  
  
  RESULTS
  Fifty-six percent of patients were females with a median age of 59 years. Seventy-six percent of patients had an identifiable comorbidity at presentation, the most common being chronic liver disease. The most frequently presenting symptom was abdominal pain and distension (60%). Twenty-four percent of patients presented with upper gastrointestinal bleeding secondary to oesophageal and/or gastric varices. Abdominal ultrasound and computed tomographical imaging were the imaging modalities most commonly used to diagnose PVT, although abdominal ultrasound missed 12% of patients subsequently diagnosed by other methods. Fifty percent of patients, who had a thrombophilia screen, were found to have a coagulopathy. Twenty-eight percent of patients were anticoagulated with warfarin with no adverse bleeding events observed. Forty-four percent of patients were placed on an endoscopic variceal band ligation programme. Nine patients died over the study period from either upper gastrointestinal bleeding, end-stage liver failure or biliary sepsis. The acturial 5-year survival was 72%.
  
  
  CONCLUSIONS
  The mortality from PVT is low and survival is related to the underlying cause. Although the diagnosis of PVT remains uncommon outside the specialist centre, both specialist and nonspecialist physicians must remain mindful of this important condition.
authors.affiliation: Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Whitechapel, London, UK.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Farmer
authors.forename: Abid
authors.initials: A
authors.lastname: Saadeddin
authors.forename: Caroline E M Bruckner
authors.initials: CE
authors.lastname: Holt
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bateman
authors.forename: Monz
authors.initials: M
authors.lastname: Ahmed
authors.forename: Wyn King
authors.initials: WK
authors.lastname: Syn
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006403:Hematologic Tests / Q000379:methods; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult