Portal vein aneurysm associated with extensive portal-mesenteric thrombosis

A 71-year-old woman with multiple non-hepatic pathologies came to the emergency room due to epigastric pain and diarrhea. On examination, she had abdominal pain with no signs of peritoneal irritation, and blood tests showed elevated acute phase reactants and HDL. Abdominal CT with intravenous contrast revealed a 3.3 cm aneurysm of the main portal vein associated with mesenteric-portal thrombosis (Fig. 1). Conservative treatment and anticoagulant therapy were initiated, and the patient was discharged on day 7 after a favorable evolution. Given the high risk for anesthesia and surgery, we decided to treat the patient with chronic oral anticoagulation (acenocoumarol). After 6 months of follow-up, the patient remains asymptomatic (Fig. 2).

Fig. 1

Fig. 2