Case Report: Portal Vein Thrombosis as a Cause of Haematemesis in a Healthy African Adolescent

Introduction: Thromboembolic incidents typically occur as deep vein thrombosis of the limbs and pulmonary embolism but can also occur in unusual sites such as cerebral or sinus, mesenteric, portal, hepatic renal and retinal veins. When thromboembolism occurs in any of these unusual sites, diagnosis is often unsuspected and missed. The relatively low incidence of thrombosis in healthy children further presents a potential diagnostic dilemma. High index of suspicion is therefore required for timely diagnosis in order to prevent complications.

Presentation of Case: We report a case of a 15 year-old girl with 10 years history of recurrent haematemesis. She was managed initially as a case of upper gastrointestinal bleeding of unknown aetiology and subsequently as a case of chronic liver disease and then later, as case of bleeding diathesis. The patient had several oesophageal variceal band ligation, courses of propranolol, omeprazole, livolin and several units of blood transfused. Abdominal ultrasound, Computed Tomographic scan of abdomen and angiography revealed portal vein thrombosis with periportal collaterals. The proteins C and S levels were low. A diagnosis of portal vein thrombosis (PVT) secondary to Proteins C and S deficiencies was then made. Patient has been symptom free since commencement of anticoagulation but there was no recanalization of the vessels.

Conclusion: The potential role of prothrombotic risk factors and PVT should be explored in paediatric age group with gastrointestinal bleeding for early diagnosis and management to reduce complications.