A rare complication of people with inflammatory bowel disease after ileostomy: A case report

Medicine · 3 authors, 1 centre

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This case report describes a 55-year-old man with Crohn's disease who developed cavernous transformation of the portal vein and portal hypertension after intestinal surgery. The report suggests early anticoagulant therapy and closer monitoring are important for IBD patients after surgery to prevent such complications.

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This is a case report of a 55-year-old male with a 9-year history of Crohn's disease who presented with asthenia, hematemesis, and diarrhea two years after undergoing enterectomy and ileostomy. Diagnostic workup, including endoscopy and imaging, confirmed gastroesophageal varices and cavernous transformation of the portal vein (CTPV), leading to portal hypertension. Follow-up at one year showed intermittent diarrhea but no further bleeding. The authors propose that surgery with simultaneous stoma formation is a significant risk factor for venous thromboembolism (VTE) in IBD patients. They emphasize the need for early anticoagulant prophylaxis and extended postoperative monitoring, especially for patients unable to receive anticoagulants. Limitations include the single-case nature and the patient's refusal of surgical or interventional treatment.

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case_report

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gastroenterology

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100% · A

ORIGINAL PAPER

PMC10508412

A rare complication of people with inflammatory bowel disease after ileostomy: A case report

Medicine

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ABSTRACT

Rationale: Venous thromboembolism is one of the common complications of inflammatory bowel disease (IBD), which is a significant health problem worldwide. Factors such as inflammation, medications, and abdominal surgery, contribute to the increased risk of venous thromboembolism in patients with IBD. Cavernous transformation of the portal vein (CTPV) is a relatively rare complications of IBD. Subsequent portal hypertension could be fatal and the clinical treatment is difficult. Thus, early prevention is very crucial. Patient concerns: A 55-year-old man presented to our department with asthenia, hematemesis, and diarrhea. He was diagnosed with Crohn disease for 9 years. Two years ago, He suffered intestinal perforation and received enterectomy and ileostomy. And, anticoagulants were not given during perioperative period and after surgery because of the history of gastrointestinal bleeding. Diagnoses: The patient was given endoscopy inspection showing the varices of esophagus and gastric fundus near cardia. Contrast enhancement CT scan showed portal hypertension, CTPV, gastroesophageal varices, and splenomegaly. Then percutaneous transhepatic portography was performed to make a clear diagnosis. Interventions: Concerned about the risk of surgery, he refused surgical shunting. Conservative treatment was recommended due to technical difficulties instead of interventional therapy. Outcomes: And after a period of fasting, blood transfusion, and parenteral nutrition treatment, the patient did not experience any further vomiting or hematemesis. Lessons: Early identification and treatment of CTPV is difficult. Prevention such as early application of anticoagulant is necessary for patients with IBD undergoing surgery, particularly with simultaneous stoma formation. For IBD patients who are not suitable for anticoagulant therapy, postoperative follow-up monitoring should be more frequent and monitoring time should be extended.

CITATION EXPORT

Hong Jiang, Shengduo He, Huahong Wang. A rare complication of people with inflammatory bowel disease after ileostomy: A case report. Medicine. (2023). https://doi.org/10.1097/MD.0000000000035098

AUTHORS

3 · 1 CENTRES

Hong Jiang, Shengduo He, Huahong Wang

a Department of Gastroenterology, Peking University First Hospital, Beijing, China.