Quan Xin, Tai Yang, Wei Bo, Tong Huan, Wang Zhidong, Yang Yuhang, Wu Hao
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
Laboratory of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.
Front Med (Lausanne). 2021 Oct 28;8:778672. doi: 10.3389/fmed.2021.778672. eCollection 2021.
Abdominal tuberculosis is one of common forms of extra-pulmonary tuberculosis. However, portal vein involvement leading to portal venous stenosis and portal hypertension is a rare complication in abdominal tuberculosis. Because of the non-specific presentations and insensitive response to anti-tuberculosis therapy of the lesions involving portal vein, it continues to be both a diagnostic and treatment challenge. We have reported a 22-year-old woman presented with massive ascites and pleural effusion, which was proved to be TB infection by pleural biopsy. After standard anti-tuberculosis therapy, her systemic symptoms completely resolved while ascites worsened with serum-ascites albumin gradient >11 g/L. Contrast-enhanced computed tomography and portal venography showed severe main portal vein stenosis from compression by multiple calcified hilar lymph nodes. Finally, the patient was diagnosed with portal venous stenosis due to lymphadenopathy after abdominal tuberculosis infection. Portal venous angioplasty by balloon dilation with stent implantation was performed and continued anti-tuberculosis therapy were administrated after discharge. The ascites resolved promptly with no recurrence occurred during the six-month follow-up. Refractory ascites due to portal venous stenosis is an uncommon vascular complication of abdominal tuberculosis. Portal venous angioplasty with stent placement could be a safe and effective treatment for irreversible vascular lesions after anti-tuberculosis therapy.
腹部结核是肺外结核的常见形式之一。然而，门静脉受累导致门静脉狭窄和门静脉高压是腹部结核中一种罕见的并发症。由于涉及门静脉的病变表现不具特异性且对抗结核治疗反应不敏感，它仍然是诊断和治疗上的挑战。我们报告了一名22岁女性，表现为大量腹水和胸腔积液，经胸腔活检证实为结核感染。经过标准抗结核治疗后，她的全身症状完全缓解，但腹水加重，血清腹水白蛋白梯度>11 g/L。对比增强计算机断层扫描和门静脉造影显示，多条钙化的肺门淋巴结压迫导致严重的门静脉主干狭窄。最终，该患者被诊断为腹部结核感染后因淋巴结病导致门静脉狭窄。通过球囊扩张和支架植入进行门静脉血管成形术，并在出院后继续给予抗结核治疗。腹水迅速消退，在六个月的随访期间未复发。由门静脉狭窄导致的难治性腹水是腹部结核一种罕见的血管并发症。门静脉血管成形术联合支架置入术可能是抗结核治疗后不可逆血管病变的一种安全有效的治疗方法。
