Thirty-four adult patients with portomesenteric venous occlusion (PVO) were reviewed. In 11 with
hepatic cirrhosis, PVO was usually heralded by worsening
ascites often with
varix hemorrhage; mortality was high. Four with isolated portal block had
varix hemorrhage without
ascites. All of these patients survived despite recurrent
hematemesis when portal
decompression was not feasible in two patients. Eight others (5 agnogenic and 3 with
hypercoagulability), experienced sudden
abdominal pain with a clot typically propagated into mesenteric tributaries with ileojejunal
infarction; survival was related to the promptness of operation and the extent of bowel
ischemia. Of five patients with intraabdominal
sepsis and pylephlebitis, only one survived. In the final six patients, PVO occurred with intraabdominal
carcinoma. Five had progressive
ascites,
cachexia, and an early death. Imaging techniques included plain and contrast roentgenograms, ultrasonography, and for definitive diagnosis direct portography (operative or splenoportogram), indirect portography (splanchnic arteriovenogram), and computed tomography. Thirteen of 34 patients had
ascites, and in nine of 11 patients examined,
protein concentration of ascitic fluid was extremely low (less than 0.6 g/dl). Clinical presentation of PVO varies, depending on acuteness and extent of visceral venous blockade, severity of
portal hypertension, auxiliary venous collateralization, and regional lymph flow. Inciting factors include endothelial damage and blood
hypercoagulability from
trauma,
infection, stagnant circulation, blood dyscrasia, and
malignancy. Improved imaging now allows early diagnosis.