# Extensive Portal Vein Thrombosis Following Laparoscopic Cholecystectomy: Interplay of Liver Cirrhosis, Psoriasis, and Anticoagulation Oversight

## TL;DR

A patient with liver cirrhosis and psoriasis developed severe blood clots in the portal vein after surgery due to missed anticoagulation, highlighting risks in patients with multiple clotting risk factors.

## Contribution

Highlights the interplay between liver cirrhosis, psoriasis, and anticoagulation oversight in causing portal vein thrombosis.

## Key findings

- A patient with untreated psoriasis and liver cirrhosis developed extensive portal vein thrombosis after surgery.
- The patient's clotting disorder was linked to decreased antithrombin III, factor II, and protein C activity.
- Postoperative follow-up and anticoagulation management are critical in patients with multiple thromboembolic risk factors.

## Abstract

Portal vein thrombosis (PVT) is a rare but serious condition often associated with liver cirrhosis, malignancy, and hypercoagulable states. While PVT following laparoscopic surgery is uncommon, certain risk factors can predispose patients to this complication. A 65-year-old male with a history of untreated plaque psoriasis and alcoholic liver cirrhosis with portal hypertension developed PVT after a robot-assisted laparoscopic cholecystectomy. The patient presented with abdominal swelling and mild epigastric pain two months postoperatively. Imaging revealed an occlusive thrombus in the portal vein extending into the splenic and superior mesenteric veins, accompanied by bowel congestion, edema, and early signs of ischemia. The patient had been on warfarin prior to surgery for an unclear reason but had failed to resume warfarin use postoperatively due to a lack of follow-up with his primary care physician. After managing the patient's PVT with a heparin drip followed by apixaban, his symptoms improved. A thrombophilia panel revealed decreased activity of antithrombin III, factor II, and protein C. Thorough preoperative history-taking and postoperative primary care follow-up are essential, particularly in patients with multiple thromboembolic risk factors. The unexpected role of untreated psoriasis as a potential contributor to PVT highlights the need for further research into the systemic effects of chronic inflammatory conditions.