A 33-year-old man with no relevant past medical history and no known family history of thrombosis presented to the emergency department with intermittent diffuse abdominal pain of several days duration with nausea and vomiting.
Physical examination revealed diffuse abdominal pain with no signs of peritoneal irritation.
The most relevant analytical data were: glucose 84 mg/dl, urea 30 mg/dl, creatinine 0.9 mg/dl, amylase 29 U/l, lactic acid-dehydrogenase 30 mg/dl fibrin/dl, platelets 1887 mg/dl total reactive protein 5700 mg/dl, platelet activity
An abdominal ultrasound showed a portal vein of increased caliber (1.6 cm diameter), with absence of flow inside the Doppler study.
Abdominal computed tomography showed thrombosis of the portal vein and superior mesenteric vein, with no other abnormalities.
The patient was treated with enoxaparin (1 mg/kg every 12 hours) for 10 days, with a favorable outcome, and subsequently continued treatment with acenocoumarol.
The thrombophilia study identified a heterozygosis for the G20210A mutation of the prothrombin gene, being normal or negative the Leiden factor V, the resistance to the anticardiolipin protein IgG homocysteine, the IgM
An angioresonance performed 10 months later showed the existence of a 15-cm anomegaly and a portal vein of increased cavernous size with cavernous transformation (with small periportal collateral vessels).
An oral endoscopy performed 14 months after the initial presentation was normal.
After 15 months of follow-up in treatment with acenocoumarol, the patient remains asymptomatic.
