Acute portal vein thrombosis simulating acute pancreatitis: about a clinical case at the National University Hospital of Cotonou

Abstract

Introduction: Portal vein thrombosis (PVT) is a rare disease in the absence of cirrhosis. Its clinical signs are non-specific and depend on when the diagnosis is made. The clinical case we are reporting highlights the possibility of diagnostic wandering, the contribution of imaging and the value of systematic etiological assessment. Observation: We report here a 49-year-old patient with a large uterine myoma. She had consulted for a very intense transfixing epigastric pain, aggravated by meals and slightly relieved by fasting. An upper digestive endoscopy performed a few days after the beginning had revealed very intense erythematous gastritis. Lipasemia was normal. In view of the persistence of the symptoms despite appropriate treatment of gastritis, an abdominal CT scan concluded that there was a portal vein thrombosis. The etiological assessment did not show arguments in favour of cirrhosis, hepatocarcinoma, pancreatitis or pancreatic adenocarcinoma, but revealed HIV infection. The evolution was quickly favourable under anticoagulant. Conclusion: Although non-specific, abdominal pain is the most common symptom of acute PVT. The diagnosis is based on the Doppler ultrasound and/or abdominal CT. The presence of a local or regional factor should not exclude the search for general causes such as HIV infection.