Portal Thrombosis: Clinical, Etiological and Therapeutic Aspects in the Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar (Senegal)

Abstract

Background: Portal thrombosis (PT) is a rare pathology. Its prevalence is es timated at 1%. Its consequences depend on the acute or chronic nature, the extent of the clot and the etiology. In Sub-Saharan Africa, very few studies have been devoted to it. Patients and Method: The objective of our work was to determine the prevalence of PT and to describe its clinical and etiological presentation as well as its therapeutic management in the Hepa to-gastroenterology department of the Aristide Le Dantec hospital in Dakar. This was a retrospective, longitudinal and descriptive study during the period from January 1, 2012, to December 31, 2018. It included all patients followed in ambulatory or inpatient, who presented a PT objectively determined by a medical imaging examination (ultrasound and/or CT scan). Age, gender, clinical and radiological aspects, proposed treatments and etiology of PT were collected. Results: We collected 71 observations. The prevalence of PT was 1.9%. The mean age of the patients was 41 years 15 and 75 years. A predominance of men was found with a sex ratio of 2.73. The clinical manifestations were dominated by abdominal pain (74.6%), ascites (35.7%) and gastrointestinal bleeding (25.4%). Imaging allowed the diagnosis to be made in 50 patients on ultrasound and 21 patients on abdominal CT scan. PT was acute in 5 patients and chronic in 66 patients. Thrombosis was complete in 71.4% of cases and extended to the spleno-mesaraic venous trunk and the superior mesenteric vein in 2.8% and 8.4% respectively. Etiological research found cirrhosis complicated by hepatocellular carcinoma in 67.6% of cases, cirrhosis with cruoric thrombosis in 21.1% of cases, a combined protein C and S deficiency in 1.4% of cases. No aetiology was objectified in 9.9% of cases. Treatment with beta-blockers was initiated in 32 patients. Anticoagulant treatment was performed in one patient. Evolutionarily, no recurrence of bleeding was noted. In the anticoagulated patient, PT remained stable; however, there was no portal vein recanalization. During follow-up, mortality was 74.6% and was related to the underlying pathology in all patients. Conclusion: PT has a prevalence of 1.9% in the Hepato-Gastroenterology Department of the Aristide Le Dantec Hospital in Dakar. The chronic form is very dominant and degenerated cirrhosis is the first etiology.