Document Detail


Portal vein thrombosis associated with coronary artery bypass surgery.
MedLine Citation:
PMID:  18212699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Portal vein thrombosis is a rare but well-known complication after abdominal surgery. To our knowledge, there have been no reports about this complication after cardiopulmonary bypass surgery. This can probably be explained by the variety of clinical pictures and difficulties in the establishment of a diagnosis of portal vein thrombosis. Among the possible trigger factors, bacteremia, that is usually caused by Bacteroides fragilis or by Escherichia coli, has been assessed. In this case, several blood culture specimens and fluid from abdominal paracentesis consistently grew coagulase-negative staphylococci which have been proved to be one of the most common pathogens in postoperative infection after cardiac surgery. The patient received clopidogrel before and after coronary artery bypass grafting. We speculate that in this clinical situation associated with coagulase-negative staphylococcal bacteremia, clopidogrel resistance may play an important role. The natural history of portal vein thrombosis in this case is complicated by massive fatal gastrointestinal bleeding from rupture of the esophageal varices. Emergency endoscopic therapy with esophageal variceal ligation, injection of a sclerosing solution and using of vasoconstrictive agents helped only in the first episode of bleeding. Portal vein thrombosis after coronary artery bypass grafting is a serious complication. The clinical picture of portal vein thrombosis may vary greatly and the presence of this condition should be suspected when faced with abdominal pain with gastrointestinal bleeding of unknown origin and sepsis.
Authors:
M G Katz; M Shimonov; S Elias; M Ben Eli; E Hauptman; L Sasson
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  49     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-23     Completed Date:  2008-03-28     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  129-31     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, E. Wolfson Medical Center, Holon, Israel.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aspirin / adverse effects*
Bacteremia / complications*,  etiology,  microbiology,  therapy
Coagulase / deficiency
Coronary Artery Bypass / adverse effects*
Esophageal and Gastric Varices / etiology,  therapy
Fatal Outcome
Gastrointestinal Hemorrhage / etiology,  therapy
Humans
Male
Platelet Aggregation Inhibitors / adverse effects*
Portal Vein* / drug effects,  microbiology,  radiography
Staphylococcus / enzymology,  isolation & purification*
Ticlopidine / adverse effects,  analogs & derivatives*
Tomography, X-Ray Computed
Treatment Failure
Treatment Outcome
Venous Thrombosis / chemically induced,  complications,  diagnosis*,  etiology,  microbiology,  therapy
Chemical
Reg. No./Substance:
0/Coagulase; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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