Gastroenterologie
a hepatologie

Prehepatic portal hypertension

Štěpán Šembera ^{Orcid.org  1}, Petr Hůlek^1,2, Václav Jirkovský ^{Orcid.org  1}, Tomáš Fejfar ^{Orcid.org  1}, Antonín Krajina ^{Orcid.org  3}, Petr Dulíček ^{Orcid.org  4}, Miroslav Lojík³, Jan Raupach³, Vendelín Chovanec ^{Orcid.org  3}, Ondřej Renc ^{Orcid.org  3}, Zdeněk Šubrt ^{Orcid.org  5}, Marcela Kopáčová ^{Orcid.org  6}

+ Affiliation
¹ II. interní gastroenterologická klinika LF UK a FN Hradec Králové
² Katedra interní oborů, LF OU v Ostravě
³ Radiologická klinika LF UK a FN Hradec Králové
⁴ IV. interní hematologická klinika LF UK a FN Hradec Králové
⁵ Chirurgická klinika LF UK a FN Hradec Králové
⁶ II. interní klinika – gastroenterologie, LF UK a FN Hradec Králové

Summary

Introduction: Prehepatic portal hypertension (PH) in the absence of cirrhosis and solid tumours is most commonly caused by thrombosis of the portal vein (PT). Thrombosis in the portal system manifests as either acute abdominal pain or occurs silently, and varices develop in response to increased portal blood pressure. In 2016, the European Association for the Study of the Liver issued a new clinical practical guideline for the treatment of PT. To treat acute PT, it is advised that anticoagulation therapy is initiated immediately. It is recommended to treat patients with chronic PT by the same way as patients with PH caused by liver cirrhosis. Aim: The aim of this study was to describe a group of patients with portal thrombosis at the University Hospital in Hradec Kralove (FNHK) and to compare the therapeutic approaches used with those of the new guidelines. Method: Retrospective description of all patients treated for the above-mentioned portal thrombosis in the FNHK that were identified in electronic records. Results: The cohort consisted of 52 patients (27 males and 25 females); 44 patients with chronic PT, six with acute PT, and two with subacute PT. All patients with acute or subacute PT had been receiving anticoagulant therapy. Up to that point, five patients had undergone transjugular intrahepatic portosystemic shunt (TIPS), four of whom had local thrombolysis. Patients with chronic PT were treated the same as patients with PH and liver cirrhosis. Up to that point, six spleno-renal shunt procedures, nine splenectomy procedures, seven azygo-portal disconnection procedures, four TIPS procedures, one mesentero-caval shunt procedure, and one splenic embolization procedure had been performed. Discussion and Conclusion: Treatment of patients in our study group meets the challenges of the new recommendations. In complicated cases, other therapeutic approaches may be necessary.

Keywords

Literature

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