Undiagnosed diabetes mellitus presenting as thrombosis of the portal venous system: case report

Abstract

Introduction: Thrombosis of the portal venous system is rare with prevalence near 1% in the general population reported previously, difficult to diagnose and can be fatal. Case presentation: A 54 year-old white female was admitted to our hospital with 10 days history of vague abdominal pain, nausea, vomiting and fever. Last months she had symptoms suggestive of diabetes mellitus. The degree of her subjective pain was disproportionate to her objective tenderness. Laboratory work-up revealed hyperglycemia, HbA1c 12,4 %,a high total leukocyte count ,lipase and amylase were normal,AST, ALT initially were normal. In the urine-analysis resulted urinary infection and positive ketone. An abdominal computed tomography (CT) with contrast had permitted the diagnosis of portal vein, splenic vein and superior mesenteric vein thrombosis associated with extensive hepatic, lineal, infarction and a tromb in descendent aort. Immediately, an anticoagulant therapy was conducted with intravenous heparin, but after 45 days treatment she died. Results: In our case, the thrombus was secondary to a combination of comorbidities, including dehydration, urinary infection, ketosis and diabetes mellitus and the diagnoses was not made in time. Only a CT abdominal permitted the diagnosis of portal venous system thrombosis. Despite the anticoagulant therapy the result was fatal.