Dhanush Hoskere, DO
Bayonne, New Jersey
Dhanush Hoskere, DO1, Kovil Ramasamy, MD2, John Dedousis, MD3, Antonios Tsompanidis, DO3
1Bayonne Medical Center-CarePoint Health, Bayonne, NJ; 2Rowan University School of Osteopathic Medicine, Stratford, NJ; 3CarePoint Health, Bayonne, NJ
Introduction: In patients with pancreatitis and pancreatic pseudocysts, the risk of splenic vein compression is well known. The portal vein is a rare location for compression. Here, we have a rare case of a Pakistani male found to have portal vein compression by the pancreatic head.
Case Description/Methods: 44-year-old Pakistani male with past medical history of cirrhosis, chronic pancreatitis with surgical resection of pancreatic pseudocysts, diabetes mellitus type II, and cholecystitis with cholecystectomy presented with worsening sharp periumbilical abdominal pain, nausea, and non-bloody/non-bilious vomiting for 3 days. Pain was exacerbated by food consumption and relieved with tramadol. Patient denied associated fever, chills, and diarrhea. Physical exam findings included soft abdomen with diffuse abdominal tenderness worse in the epigastric and right upper quadrant areas. Patient had voluntary guarding. Patient did not have scleral icterus or jaundice on exam. Laboratory findings included leukocytosis of 12.4, elevated lactate at 3, elevated triglycerides at 823, unremarkable lipase at 160, and unremarkable bilirubin at 1.5. Patient had unremarkable AST, ALT, and alkaline phosphatase. Patient was treated for chronic pancreatitis by restarting home pancrelipase and slowly progressing diet. Abdominal CT showed markedly abnormal pancreas including inflamed pancreatic head and body with pseudocyst formation present. The portal vein was compressed by the pancreatic head. Recommendation for patient was for portal venous stenting, however, patient did not want intervention at that time.
Discussion: Portal hypertension is a serious condition, leading to complications including varices, ascites, and hepatic encephalopathy. Cirrhosis is the most common cause of portal hypertension in the western world. In developing countries, there is a higher incidence of extrahepatic causes, such as external compression. The splenic vein is the most common location for extrinsic compression; however, this case demonstrates the rare incidence of portal vein compression. Thus, the risk of compression as the cause of portal hypertension must be taken into consideration in the immigrant population. In addition, this patient did not exhibit symptoms significant for portal hypertension complications. Since many of these patients are asymptomatic in relation to portal hypertension, these patients should be screened for portal vein compression to help prevent complications that can arise from portal hypertension.
Citation: Dhanush Hoskere, DO; Kovil Ramasamy, MD; John Dedousis, MD; Antonios Tsompanidis, DO. P1864 - PORTAL VEIN COMPRESSION IN LIGHT OF CHRONIC PANCREATITIS. Program No. P1864. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.