背景:在炎症性肠病患者中,血栓事件的发生率是普通人群的两倍多。我们报告了一个有趣且罕见的门静脉血栓形成病例,这是克罗恩病肠外表现的静脉血栓栓塞事件。我们还对与炎症性肠病相关的门静脉血栓形成进行了文献综述,具有以下概念:炎症性肠病,溃疡性结肠炎,克罗恩病,门静脉,和血栓形成。
方法:一名24岁的叙利亚女性患有活动性慢性克罗恩病,11年前被诊断为A1L3B1P。她之前没有手术史。她以前的药物包括硫唑嘌呤和泼尼松龙。她的克罗恩病活动指数为390分。胃十二指肠镜检查显示Ⅰ级食管静脉曲张,门静脉高压症的并发症。同时,结肠镜检查显示乙状结肠有几个深层溃疡,直肠,和降结肠。对门静脉高压症的调查显示门静脉血栓形成。我们用皮质类固醇来诱导缓解,随后逐渐减量;此外,她还接受了ustekinumab来诱导和维持缓解。她开始服用低分子量肝素1周,华法林3个月,然后是阿哌沙班,一种新型口服抗凝剂,排除抗磷脂综合征后。不需要对食管静脉曲张进行初级预防。一年后,她取得了临床成就,生物化学,和内窥镜缓解。尽管治疗了一年,计算机断层扫描显示门静脉再通没有改善.
结论:门静脉血栓形成是一种罕见且定义不清的炎症性肠病并发症。通常由炎症性肠病加重。症状是非特异性的,可能模仿炎症性肠病的发作,使诊断变得困难。住院炎症性肠病患者的门静脉多普勒超声可能有助于这种并发症的诊断和治疗。
BACKGROUND: Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn\'s disease. We also conducted a literature
review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn\'s disease, portal vein, and thrombosis.
METHODS: A 24-year-old Syrian female with active chronic Crohn\'s disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn\'s disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization.
CONCLUSIONS: Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication.