Intra-abdominal hypertension triggered by portal vein thrombosis postoperatively: an ignored, but potential, cause of acute kidney failure in patients with cirrhosis

Abstract

Intra-abdominal hypertension (IAH), even abdominal compartment syndrome, resulting from major stem portal venous thrombosis (MSPVT) postoperatively can lead to acute kidney failure (AKF). However, few physicians consider this clinical presentation, which is rarely reported in the literature. IAH often induces a few obvious clinical presentations, such as oliguria, anuria, and abdominal distension, etc., even in cases with normal liver function. Many doctors consider that AKF is due to hepatorenal syndrome (HRS), while postoperative development of portal vein thrombosis (PVT) may be another important factor inducing AKF, which appears to have been ignored in recent years. In fact, devascularization surgery and/or shunt placement for treatment of portal hypertension are known to easily induce PVT, especially during devascularization procedures because of the rapid accumulation of platelets. In addition, the risk of hypercoagulability increases because of the use of hemostatic agents. Also, PVT may lead to gastro-intestinal congestion and tissue edema, which can contribute to the development of IAH. Abdominal distension became very obvious because collateral circulation could not be restored in time due to MSPVT after ligamentectomy surrounding the liver. Thus, it was difficult to arrive at a diagnosis of PVT at an earlier stage by B-type ultrasound and/or measurement of D-dimer levels. To achieve an early diagnosis, it is very important to actively incorporate the methods mentioned above. However, these methods are not recommended unless the diagnosis of HRS is definitive. The effective treatment is to administer anticoagulants, such as low-molecular-weight heparin, and to discontinue hemostatic agents in time. AKF will not benefit from Terlipressin if HRS was not considered as the major cause of AKF, especially in cases of IAH. It is well known that peritoneal dialysis and/or hemodialysis should be adopted to sustain kidney function postoperatively.