Extrahepatic Portal Venous Obstruction With Hepatic Enzyme Elevation Resembling Hepatitis in Patients With Cancer

Abstract

Background/Aim: Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. We investigated EHPVO with hepatic enzyme elevation in patients with cancer. Patients and Methods: Data of these hospitalized patients with solid tumors between January 2013 and September 2017 were collected. The criteria for study inclusion were: (i) Extrahepatic malignancy; (ii) computed tomographic scans showing a tumor with external compression of the extrahepatic portal vein; and (iii) serum aminotransferase (AST) or alanine transaminase (ALT) level three times above the normal value. Results: Thirteen out of 377 (3%) patients developed EHPVO with hepatic enzyme elevation, as demonstrated from computed tomographic scan. Four cases (31%) also had vascular thrombosis (three portal vein and one inferior vena cava). Serum AST increased from 34±11 to 169±94 U/l. ALT increased from 9±38 to 177±104 U/l. There was no relationship of EHPVO with viral markers and cirrhosis. Six cases received chemotherapy with liver function improvement. Conclusion: EHPVO occurred in patients with metastatic cancer, leading to hepatic enzyme elevation resembling hepatitis without hepatitis risk factors and cirrhosis. Before withholding chemotherapy due to hepatic enzyme elevation, the possibility of EHPVO should firstly be excluded.Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. The portal vein is located in the right upper quadrant of the abdomen, originating behind the upper edge of the pancreatic head (1). The portal venous system is responsible for draining the blood from the spleen and parts of the gastrointestinal tract to the liver (1). The superior and inferior mesenteric veins join the splenic vein form the portal vein (1). EHPVO is a hepatic vascular disorder which results in obstruction and cavernomatous transformation of the portal vein outside the liver, which may or may not involve intrahepatic portal vein, splenic vein, or mesenteric vein. Cirrhosis of the liver and neoplasms in adults are the most common etiology of EHPVO (2-4). Such tumors can cause compression or direct invasion of the portal vein and lead to thrombosis by inducing a hypercoagulable state. The development of collateral circulation also has the risk of varices bleeding (2-4). Hepatic enzyme elevation represents liver injury; such hepatic dysfunction is not uncommon in patients with EHPVO. Liver transaminases (5), including aspartate aminotransferase (AST) and alanine transaminase (ALT), are two of the most useful measures of liver injury (6).In this case series study, we investigated EHPVO with hepatic enzyme elevation in patients with cancer. Findings of their abdominal computed tomography (CT) scans and management were also...

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