P1021 - Dehydration Causing Portal Vein, and Splenic Vein Thrombosis in a Healthy Adult

Murad Qirem, MD¹, Shahd Yaghi, MD², Amaar Ahmad, MD², Rewanth Katamreddy, MD³, Theodore DaCosta, MD², Saraswathi Lakkasani, MD^2
1Saint Michael's Medical Center, Newark, NJ; ²Saint Michael's Medical Center, Newark, NJ; ³Saint Michael’s Medical Center, Newark, NJ

Introduction: Portal vein thrombosis (PVT) is a narrowing or blockage of the portal vein by a blood clot. Thrombosis can develop in the main body of the portal vein or its intrahepatic branches and may even extend to the splenic or superior mesenteric veins (SMV). PVT frequently occurs with cirrhosis of the liver. Dehydration is a known independent risk factor for the development of thrombosis; however there is insufficient evidence to form a strong association.

In this case we present a case of 48 year old male who presented with portal vein superior mesentric vein and splenic vein thrombosis with dehydration as the only risk factor.

Case Description/Methods: A 48 year old healthy male, who presented complaining of abdominal pain for the past 6 days, described as dull epigastric pain, 10/10 that radiates to his back. He reports that he recently immigrated from Brazil to USA and underwent a strenuous journey which involved walking across Mexico for 40 days where he had limited access to water and food. On examination there was no tenderness on palpation, and abdominal sounds were normal.

On laboratory workup amylase, lipase, LFTs, Alkaline phosphatase, were normal. Since the exam and laboratory workup does not explain why he would have 10/10 pain, a CT angiogram of the abdomen was ordered, which showed: Hyperdense acute thrombotic occlusion of the portal vein, superior mesenteric vein and splenic vein.

Hypercoagubality workup was done: PT, PTT, INR normal. Factor S and C activity normal. Flow cytometry for PNH was normal. Factor II gene mutation not detected. Antithrombin III normal. Factor 5 leiden not detected. ANA, anticardiolipin, beta 2 microglobulin, and lupus anticoagulant negative. CEA, CA19-9, and AFP normal.

Since all his workup was negative, this massive thrombosis was attributed to dehydration in the extreme circumstances he went through, and he was started bridged to warfarin.

Discussion: In adult and pediatric cerebral thrombosis due to dehydration has been reported. However, there is no published case report that the authors are aware of that presents the findings of a portal vein thrombosis provoked by dehydration in a young, healthy adult, in which dehydration was suggested as a possible cause.


Disclosures:


Murad Qirem, MD¹, Shahd Yaghi, MD², Amaar Ahmad, MD², Rewanth Katamreddy, MD³, Theodore DaCosta, MD², Saraswathi Lakkasani, MD². P1021 - Dehydration Causing Portal Vein, and Splenic Vein Thrombosis in a Healthy Adult, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.