CASE 299: PORTAL VEIN FOREIGN BODY, Dr PHAN THANH HẢI, MEDIC, MEDICAL CENTER, HCMC, VIETNAM

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Woman 65 yo, epigatric pain for one week, cannot eat  and  no fever.

Ultrasound of abdomen  in decubitus position  detected  vena porta thrombosis and some  white lines intra portal vein which  came from the wall of gastric  antrum (see 4  ultrasound  pictures  in ventral view).

For clear viewing of  portal  vein  we  scanned  the liver  by sitting position and dorsal view.

Portal vein  was in distension, no flow  due to  thrombosis, and  in crossed section of portal vein we detected a white foreign body.( 2  pictures  with  sitting position scan ).

MSCT with CE  for  evaluation portal vein found out  the  foreign body which  length of 5 cm  intra left  branch of portal vein and one another end was intra gastric antrum wall.

The foreign body was  covered by thrombosis intra  left branch of portal vein (see 3 CT  images).

Blood tests  confirmed  infection  with  rising WBC and high CRP, no  abnormal coagulation test.

With  the  past history of ultrasound  scanning in ventral and dorsal views, MSCT and blood tests, the first choice  of diagnosis was intraportal vein foreign body, which was liked toothpick in penetration the gastric wall and  entering  liver  to left branch of portal vein, that caused  portal vein thrombosis.

What is your suggestion and planning of treatment for the female patient?

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Operation this case  by  open laparotomy detected   one  bonefish with length of 5 cm which penetrated the duodenum  to left lobe of liver and entering the  vena porta  left branche.

Removing bonefish and sutured  duodenum.