P2995 - Beyond the Usual Tumble: A Rare Case of Multifocal Acute Thrombosis Following Trauma

Manuel Del Rio-Montesinos, MD, Jose Nuñez-Morales, MD, Patricia Rivera-Cariño, MD, Orlando Rodriguez-Amador, MD, Priscilla Magno, MD
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Thrombus formation lies at the heart of Virchow’s triad. While portal vein thrombosis is common in cirrhotic patients, it can also occur without hepatocellular disease. Factors like Factor-V Leiden and prothrombin G20210A increase procoagulant activity, while deficiencies in antithrombin, protein C, or protein S reduce anticoagulant function. These factors can cause portal and mesenteric vein thrombosis in noncirrhotic patients. Rarely, blunt abdominal trauma can precipitate thrombosis, especially with undiagnosed thrombophilia. Clinical manifestations include upper abdominal pain, nausea, fever, anorexia, and jaundice. We present a rare case of multiple acute thromboses following blunt trauma in a patient without coagulability disorders.

Case Description/Methods: A 56-year-old Hispanic male with no significant medical history presented with acute severe abdominal pain that began four days after a 2–3-meter fall while gardening. Initially diagnosed with acute gastritis and treated with PPIs, his pain progressed over five days. Physical exam showed epigastric and lower quadrant pain without hematoma or trauma signs. Labs revealed mild leukocytosis, stable hemoglobin and platelets, normal chemistry, elevated C-reactive protein (120.4 mg/L), and elevated fibrinogen degradation products (20 µg/mL). Coagulation studies were within normal limits. Abdominopelvic CT revealed thrombosis in the portal vein, portal splenic confluence, splenic vein, and superior mesenteric vein. The patient was started on subcutaneous enoxaparin and then transitioned to a direct oral anticoagulant. Hypercoagulability studies, including PNH and JAK-2 mutation, were unremarkable.

Discussion: Virchow’s triad encompasses factors promoting thrombus formation. In this case, endothelial injury triggered thrombus formation. However, it's crucial to consider hypercoagulability disorders like Factor V Leiden, PNH, and JAK-2 mutation. Portal vein thrombosis typically presents with acute upper abdominal pain, vomiting, anorexia, fever, and abdominal distension. This rare clinical presentation has few reported cases. Symptoms could suggest other diagnoses like pancreatitis or gastritis, but thrombosis should be considered if there's blunt abdominal trauma. Adequate follow-up is critical to monitor for complications. Patients with PVT risk developing portal hypertension, potentially leading to cirrhosis. Compliance with anticoagulation and regular primary care follow-up is essential.



Disclosures:


Manuel Del Rio-Montesinos, MD, Jose Nuñez-Morales, MD, Patricia Rivera-Cariño, MD, Orlando Rodriguez-Amador, MD, Priscilla Magno, MD. P2995 - Beyond the Usual Tumble: A Rare Case of Multifocal Acute Thrombosis Following Trauma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.