Dan Dilip, King Kevin, Seetahal Shiva, Naraynsingh Vijay, Hariharan Seetharaman
Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago.
J Med Case Rep. 2011 Mar 30;5:126. doi: 10.1186/1752-1947-5-126.
Portal vein thrombosis is an uncommon post-operative complication following abdominal surgery. Although therapeutic anticoagulation is recommended, this treatment may be questionable when the patient has an associated bleeding diathesis.
We report a case of a 63-year-old woman of Asian Indian ethnicity who developed portal vein thrombosis following an uneventful laparoscopic cholecystectomy for symptomatic gallstones. Her condition was further complicated by dengue viral infection in the post-operative period, with thrombocytopenia immediately preceding the diagnosis of portal vein thrombosis. The etiological connections between dengue viral infection with thrombocytopenia, laparoscopic cholecystectomy, portal vein thrombosis as well as the treatment dilemmas posed in treating a patient with portal vein thrombosis with a bleeding diathesis are discussed.
When portal vein thrombosis occurs in patients with contraindications to anticoagulation, there is a role for initial conservative management without aggressive anticoagulation therapy and such patients must be approached on an individualized basis.
门静脉血栓形成是腹部手术后一种不常见的术后并发症。尽管推荐进行治疗性抗凝，但当患者伴有出血倾向时，这种治疗可能存在疑问。
我们报告一例63岁的亚洲印度裔女性，她在因有症状的胆结石接受了顺利的腹腔镜胆囊切除术后发生了门静脉血栓形成。术后她的病情因登革病毒感染而进一步复杂化，在门静脉血栓形成诊断前即刻出现血小板减少。讨论了登革病毒感染伴血小板减少、腹腔镜胆囊切除术、门静脉血栓形成之间的病因联系，以及在治疗有出血倾向的门静脉血栓形成患者时所面临的治疗困境。
当抗凝治疗存在禁忌证的患者发生门静脉血栓形成时，初始保守治疗而非积极的抗凝治疗有一定作用，并且必须对这类患者进行个体化处理。
