Wongweerakit Onchuda, Akaraborworn Osaree, Sangthong Burapat, Thongkhao Komet
Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Chin J Traumatol. 2025 Jan;28(1):76-78. doi: 10.1016/j.cjtee.2023.09.003. Epub 2023 Sep 20.
Portal vein thrombosis (PVT) secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury, and it carries a high rate of morbidity and mortality. Moreover, acute asymptomatic PVT is difficult to diagnose. We present a young trauma patient with isolated minor liver injury associated with acute PVT. A 27-year-old man presented to the emergency department after a motor vehicle collision. His primary survey findings were unremarkable. His secondary survey showed a large contusion (7 × 7 cm) at the epigastrium with marked tenderness and localized guarding. The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b (according to the American Association for the Surgery of Trauma classification) extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury. The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins, and a decreased size of the hepatic lacerations. A liver function test was repeated on post-injury day 4, and it revealed improved transaminitis. The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment. The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein. The patient received intravenous anticoagulant therapy for a total of 3 months. On the follow-up visits at 1 month, 2 months, 6 months, and 1 year after the injury, the patients did not have any detectable abnormal symptoms. PVT post-blunt minor liver injury is an extremely rare complication. If the thrombosis is left untreated, serious morbidity and mortality can ensue. However, its diagnosis in asymptomatic patients is still challenging. Periodic imaging is necessary for highly suspected PVT, especially in liver injury with lacerations close to the porta hepatis, even in cases of a minor injury.
钝性腹部创伤继发门静脉血栓形成（PVT）并伴有肝损伤，在健康个体以及轻度肝损伤患者中极为罕见，且其发病率和死亡率很高。此外，急性无症状PVT难以诊断。我们报告一例年轻创伤患者，其孤立性轻度肝损伤合并急性PVT。一名27岁男性在机动车碰撞后被送往急诊科。其初次检查结果无异常。二次检查显示上腹部有一大片挫伤（7×7cm），压痛明显且有局部肌紧张。全腹CT血管造影显示肝段2/3和4b的肝损伤为3级（根据美国创伤外科学会分类），损伤延伸至肝门附近，肝静脉和门静脉通畅，无其他实体器官损伤。受伤后第7天的全腹随访CT显示左门静脉有一个1.8cm的血栓，右门静脉和肝静脉通畅，肝裂伤大小减小。受伤后第4天复查肝功能，转氨酶有所改善。患者接受了基于体重剂量的低分子量肝素静脉抗凝治疗。抗凝治疗2周后进行的全腹CT显示左门静脉有小的残留血栓。患者总共接受了3个月的静脉抗凝治疗。在受伤后1个月、2个月、6个月和1年的随访中，患者没有任何可检测到的异常症状。钝性轻度肝损伤后的PVT是一种极其罕见的并发症。如果血栓不治疗，可能会导致严重的发病率和死亡率。然而，在无症状患者中诊断它仍然具有挑战性。对于高度怀疑PVT的患者，尤其是肝裂伤靠近肝门的肝损伤患者，即使是轻度损伤病例，定期成像检查是必要的。
