2017 Volume 59 Issue 2 Pages 196-202
Here we describe a rare case of ischemic colitis complicated by acute portal vein thrombosis (PVT).
A 55-year-old man visited our hospital because of the sudden onset of lower abdominal pain and hematochezia. Abdominal contrast-enhanced computed tomography identified a density change in the area of the right branch of the portal vein, suggesting acute PVT. Colonoscopy revealed circumferential and continuous mucosal edema and hemorrhagic erythema in the descending colon. Fluoroscopic examination of the large intestine, using a water-soluble contrast agent, revealed a thumbprint sign, approximately 20 cm in length, in the descending colon. Based on both the clinical course and examination results, the patient was diagnosed with ischemic colitis. In this case, there was no history of liver disease or of any underlying condition that might have caused PVT. Furthermore, coagulation abnormalities were not observed. Therefore, the PVT was considered to have been caused by ischemic colitis. Colonoscopy performed on day 13 of the hospital stay showed marked improvement, and several longitudinal ulcer scars were observed. The patient was deemed to have made satisfactory progress and was discharged on day 16. Regarding the PVT, anticoagulant therapy was initiated during hospitalization, and two months later, disappearance of the thrombus was confirmed by abdominal computed tomography and ultrasound Doppler examination.
To the best of our knowledge, this is the second case of ischemic colitis complicated by acute PVT.
