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Portal venous gas after coagulopathy reversal

Evan R. Butlin

Department of Pulmonary and Critical Care Medicine, Naval Medical Center, San Diego, California, USA

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Ryan C. Maves

Department of Pulmonary and Critical Care Medicine, Naval Medical Center, San Diego, California, USA

Division of Infectious Diseases, Department of Internal Medicine, Naval Medical Center, San Diego, California, USA

DOI: 10.15761/CCRR.1000293

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An 84 year old female with a history of atrial fibrillation on warfarin presented with a rapidly expanding rectus sheath hematoma and an INR of 11. Her coagulopathy was reversed with 4-factor prothrombin complex concentrate (PCC). Within 24 hours, she developed abdominal pain, nausea, and lactic acidosis (lactate 5.38 mmol/L).  Computed tomography of the abdomen demonstrated portal venous gas (black arrows) and Pneumatosis intestinalis (white arrows). Emergent exploratory laparotomy revealed ischemic bowel, and she underwent resection of the ileum and ascending colon. Her postoperative course was complicated by Clostridium difficile colitis and delirium.  She was extubated on the fourth post-operative day and discharged home one week later. The presence of portal venous gas is an ominous marker for intestinal infarction requiring emergent intervention [1]. Rapid reversal of warfarin-induced coagulopathy with PCC has been associated with thromboembolic events to include stroke, myocardial infarction, and venous thromboembolism in 1.5-4.2% of treated patients [2,3] (Figures 1 and 2). 

Figure 1. HPVG B

Figure 2. Pneumoatosis intestinale B

References

  1. Abboud B, El Hachem J, Yazbeck T, Doumit C (2009) Hepatic portal venous gas: Physiopathology, etiology, prognosis, and treatment. World J Gastroenterol 15: 3585-90. [Crossref]
  2. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B (2008) Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature. Am J Hematol 83: 137-43. [Crossref]
  3. Milling TJ, Refaai MA, Sarode R, Lewis B, Mangione A, et al. (2016) Safety of a Four-factor Prothrombin Complex Concentrate Versus Plasma for Vitamin K Antagonist Reversal: An Integrated Analysis of Two Phase IIIb Clinical Trials. Acad Emerg Med 23: 466-75. [Crossref]

Editorial Information

Editor-in-Chief

Andy Goren
University of Rome "G.Marconi"

Article Type

Case Report

Publication history

Received date: December 06, 2016
Accepted date: December 22, 2016
Published date: December 24, 2016

Copyright

© 2016 Cadmus SD. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Cadmus SD, Keeling BH, Krishnan C, Soldano AC (2016) Rhabdomyomatous mesenchymal hamartoma presenting as a polypoid mass in a neonate. Clin Case Rep Rev 2: DOI: 10.15761/CCRR.1000293

Corresponding author

Simi D. Cadmus

313 East 12th St, Suite 103 Austin, TX 78701, USA; Tel: 512.324.9999 EXT. 89612; Fax: 512.475.8282.

Figure 1. HPVG B

Figure 2. Pneumoatosis intestinale B