# Case report: Rapid development of acute symptomatic portal vein system thrombosis after endoscopic variceal therapy in a patient with liver cirrhosis

## TL;DR

A cirrhotic patient developed acute portal vein thrombosis after endoscopic variceal therapy, but it was successfully treated with anticoagulation.

## Contribution

This case report highlights a rare complication of endoscopic variceal therapy and its successful management in a cirrhotic patient.

## Key findings

- Acute portal vein thrombosis occurred immediately after endoscopic variceal therapy in a cirrhotic patient.
- Low molecular weight heparin successfully recanalized the thrombosed veins without worsening bleeding.
- Anticoagulation can be safely used to treat acute PVST in cirrhotic patients despite bleeding risks.

## Abstract

Acute portal vein thrombosis (PVST), a serious complication of liver cirrhosis, is characterized as abdominal pain secondary to intestinal ischemia, and even intestinal necrosis. Anticoagulation is recommended for the treatment of acute PVST, but is often postponed in cirrhotic patients with acute variceal bleeding or those at a high risk of variceal bleeding. Herein, we reported a 63-year-old male with a 14-year history of alcoholic liver cirrhosis who developed progressive abdominal pain related to acute portal vein and superior mesenteric vein thrombosis immediately after endoscopic variceal ligation combined with endoscopic cyanoacrylate glue injection for acute variceal bleeding. Fortunately, acute PVST was successfully recanalized by the use of low molecular weight heparin. Collectively, this case suggests that acute symptomatic PVST can be secondary to endoscopic variceal therapy in liver cirrhosis, and can be safely and successfully treated by anticoagulation.