Hepatic portal venous gas and portal venous thrombosis following colonoscopy in a patient with terminal ileal Crohn's disease.
A 27-year-old man developed extensive hepatic portal venous gas (HPVG) shortly after staging colonoscopy for active, ulcerating, terminal ileal Crohn's disease. Non-operative management was instigated with broad-spectrum antibiotics and thromboprophylaxis. Radiology at 72 h demonstrated resolution of HPVG but revealed fresh non-occlusive left portal vein thrombus. Anticoagulation with warfarin was continued for 1 year, during which the thrombus initially progressed and then organised with recanalisation of the portal vein. There were no long-term clinical consequences. HPVG has previously been documented as a rare complication of inflammatory bowel disease and endoscopic intervention. We hypothesise that the barotrauma sustained during endoscopy, in association with active ulceration and mucosal friability, predisposes to the influx of gas and bacteria into the portal system. We describe successful non-operative management of HPVG in this setting and draw attention to an additional complication of portal venous thrombosis, highlighting the importance of thromboprophylaxis and serial radiological examination.
Royal Free London NHS Foundation Trust, London, UK.
Adler Shing Chak
AS
Ma
Department of Gastroenterology, Whittington Health NHS Trust, London, UK.
Iain
I
Ewing
Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
Charles Daniel
CD
Murray
Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK.
Mark Ian
MI
Hamilton
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003113:Colonoscopy / Q000009:adverse effects*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D004618:Embolism, Air / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007079:Ileitis / Q000150:complications* / Q000188:drug therapy; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014859:Warfarin