Approaches to Improving the Differential Diagnosis of Acute Portal Venous System Thrombosis

Background: Thrombosis of the portal venous system remains an insufficiently studied area within abdominal surgery. The relative rarity of the disease, its non-specific clinical presentation, difficulties in instrumental diagnostics, and the mortality rate of up to 25- 60% highlight the need to standardize the diagnostic process and underscore the relevance of research.

Objective: To evaluate the capabilities of clinical, laboratory, and instrumental diagnostic methods for portal venous system thrombosis and develop an effective clinical diagnostic algorithm.

Materials and Methods: The study included 48 patients observed between 2014 and 2024. Group 1 consisted of 22 patients (45.8%) with acute primary portomesenteric thrombosis. Group 2 included 26 patients (54.2%) with secondary thrombosis of the portal venous system. All patients underwent triplex ultrasound of the portal vein and computed tomography for thrombus visualization and assessment of linear and volumetric blood flow velocities. Statistical analysis was performed using a statistical software package.

Results: Triplex ultrasound of the portal venous system provides additional information about blood flow status even in the presence of pronounced intestinal pneumatosis, however, it has demonstrated low sensitivity and specificity in confirming the diagnosis and in differentiating between types of portomesenteric thrombosis. Computed tomography with bolus contrast enhancement was performed in 35 patients (72.9%). The obtained images clearly visualized the main vessels of the portal venous system, its major tributaries, and smaller branches. Detailed evaluation of the venous lumen, the presence of the thrombi and approximate estimation of their “age” was conducted. Furthermore, computed tomography enabled objective assessment of the extent of internal organ involvement caused by impaired portal venous blood flow.

Conclusions: The key factor for successful treatment of patients with portomesenteric thrombosis is the time interval between disease onset and the initiation of targeted therapy, which considers the clinical and pathogenetic features of different disease types.

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