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Portal Vein and Superior Mesenteric Vein Thrombosis in Nephrotic Syndrome: A Case Report and Review of Literature

腎病症候群發生肝門靜脈和上腸繫膜靜脈栓塞:一病例報告及文獻回顧

Abstracts


腎病症候群發生動脈及靜脈栓塞是並不罕見且嚴重的併發症。而腎病症候群病患發生肝門靜脈栓塞的併發症,醫學文獻只有五個病例曾經被報導過。我們報導一例26歲微細腎病變的男性病人發生急性肝門靜脈和上腸繫膜靜脈栓塞並以腹部疼痛與全身性水腫為表徵。病人一開始以抗凝劑治療,但是發生腸胃出血不得已而暫時終止抗凝劑治療雖然幾天後又恢復使用。建議外科介入治療但沒有被採用。雖然於病程危急期接受開腹手術,但是因為病人的健康狀況太差而無法施行靜脈栓塞切除術。最終病人死於小腸壞死合併破裂及嚴重的敗血症。在此篇報告中,除了報導此病例之經驗外,我們同時回顧與整理所有腎病症候群病人發生肝門靜脈栓塞的臨床表徵、治療與預後。

Parallel abstracts


Thrombosis in both the arterial and the venous circulations is a relatively frequent and serious complication of nephrotic syndrome. Only 5 cases of portal vein thrombosis (PVT) have been reported as a complication of nephrotic syndrome. We report a 26-year-old man with histologically diagnosed minimal change disease, who developed acute thrombosis of the portal and superior mesenteric vein with presentation of abdominal pain and general edema. The patient was initially treated with anticoagulant therapy. However, the medical therapy was interrupted because of gastrointestinal bleeding and was resumed a few days later. Surgical intervention was suggested but not performed until the critical period. Thrombectomy was not allowed because of poor general condition. The patient eventually died of perforation and necrosis of the small intestine and severe sepsis. In this report, a case experience is presented and we reviewed all the patients reported in the literature with regard to their clinical features, treatment modality and final outcome.

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