TITLE:
Portal Thrombosis: Clinical, Etiological and Therapeutic Aspects in the Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar (Senegal)
AUTHORS:
Salamata Diallo, Coumba Ndaw Diagne, Marie Louise Bassène, Mamadou Ngoné Gueye, Mariéme Polele Fall, Mame Aissé Thioubou, Cheikh Ahmadou Bamba Cissé, Daouda Dia
KEYWORDS:
Portal Thrombosis, Cirrhosis, Portal Hypertension
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.11 No.11,
November
4,
2021
ABSTRACT: Background: Portal thrombosis (PT) is a rare pathology. Its prevalence is estimated at 1%. Its consequences depend on the
acute or chronic nature, the extent of the clot and the etiology. In Sub-Saharan
Africa, very few studies have been devoted to it. Patients and Method: The
objective of our work was to determine the prevalence of PT and to describe its
clinical and etiological presentation as well as its therapeutic management in
the Hepato-gastroenterology department of the Aristide Le Dantec
hospital in Dakar. This was a retrospective, longitudinal and descriptive study
during the period from January 1, 2012, to December 31, 2018. It included all
patients followed in ambulatory or inpatient, who presented a PT objectively
determined by a medical imaging examination (ultrasound and/or CT scan). Age, gender, clinical and radiological aspects, proposed
treatments and etiology of PT were collected. Results: We collected
71 observations. The prevalence of PT was 1.9%. The mean age of the patients
was 41 years 15 and 75 years. A predominance of men was found with a sex ratio
of 2.73. The clinical manifestations were dominated by abdominal pain (74.6%),
ascites (35.7%) and gastrointestinal bleeding (25.4%). Imaging allowed the
diagnosis to be made in 50 patients on ultrasound and 21 patients on abdominal
CT scan. PT was acute in 5 patients and chronic in 66 patients. Thrombosis was
complete in 71.4% of cases and extended to the spleno-mesaraic venous trunk and
the superior mesenteric vein in 2.8% and 8.4% respectively. Etiological
research found cirrhosis complicated by hepatocellular carcinoma in 67.6% of
cases, cirrhosis with cruoric thrombosis in 21.1% of cases, a combined protein
C and S deficiency in 1.4% of cases. No aetiology was objectified in 9.9% of
cases. Treatment with beta-blockers was initiated in 32 patients. Anticoagulant
treatment was performed in one patient. Evolutionarily, no recurrence of
bleeding was noted. In the anticoagulated patient, PT remained stable; however,
there was no portal vein recanalization. During follow-up, mortality was 74.6%
and was related to the underlying pathology
in all patients. Conclusion: PT has a prevalence of 1.9% in the
Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar.
The chronic form is very dominant and degenerated cirrhosis is the first
etiology.