warfarin and Ileitis

A 27-year-old man developed extensive hepatic portal venous gas (HPVG) shortly after staging colonoscopy for active, ulcerating, terminal ileal Crohn's disease. Non-operative management was instigated with broad-spectrum antibiotics and thromboprophylaxis. Radiology at 72 h demonstrated resolution of HPVG but revealed fresh non-occlusive left portal vein thrombus. Anticoagulation with warfarin was continued for 1 year, during which the thrombus initially progressed and then organised with recanalisation of the portal vein. There were no long-term clinical consequences. HPVG has previously been documented as a rare complication of inflammatory bowel disease and endoscopic intervention. We hypothesise that the barotrauma sustained during endoscopy, in association with active ulceration and mucosal friability, predisposes to the influx of gas and bacteria into the portal system. We describe successful non-operative management of HPVG in this setting and draw attention to an additional complication of portal venous thrombosis, highlighting the importance of thromboprophylaxis and serial radiological examination.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Colonoscopy; Crohn Disease; Embolism, Air; Humans; Ileitis; Liver; Male; Portal Vein; Prognosis; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Acute Disease; Adult; Diagnosis, Differential; Fluid Therapy; Humans; Ibuprofen; Ileitis; Ketorolac Tromethamine; Male; Platelet Aggregation Inhibitors; Pressure; Testis; Thrombophilia; Thrombosis; Tomography, X-Ray Computed; Warfarin