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A 62-Year-Old Man with Abdominal Pain
Article Number: SIS906341AI220525
22nd May, 2025
Author(s):
Gabrielle K. Bromberg, M.D.; Robert G. Rasmussen, M.D., Ph.D.; Kenneth E. Sherman, M.D., Ph.D.; Sanjeeva P. Kalva, M.B., B.S.; Katayoon Goodarzi, M.D
Abstract:
A 62-year-old man presented with postprandial abdominal pain worsening over two years, alongside weight loss, nausea, and an irreducible umbilical hernia. While living in Costa Rica, he was diagnosed with cirrhosis, but no medical records from that time were available. Imaging revealed extensive mesenteric varices, portal vein thrombosis (PVT), cavernous transformation, and splenomegaly. Despite these findings, laboratory tests showed normal albumin levels and international normalized ratio (INR), questioning the cirrhosis diagnosis.
A liver biopsy showed hepatic atrophy without cirrhosis, suggesting chronic PVT as the primary cause of his condition. His medical history included abdominal trauma from a motor vehicle crash five years earlier, potentially triggering endothelial damage leading to thrombosis. The patient underwent transjugular intrahepatic portosystemic shunt (TIPS) placement, angioplasty of the portal and splenic veins, and anticoagulation therapy. Follow-up imaging confirmed patency of the TIPS, but recurrent postprandial nausea indicated persistent mesenteric congestion. Despite ongoing symptoms, his weight stabilized, and no clot extension was detected.