{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:42Z","timestamp":1740126822271,"version":"3.37.3"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Gastroenterol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Non-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode due to insufficient reduction of the portal pressure. Additionally, embolization of the dilated V. coronaria ventriculi led to the regression of esophageal varices but resulted simultaneously in a left-sided portal hypertension (LSPH) with development of stomach wall and perisplenic varices. After a third episode of acute esophageal varices bleeding, a surgical distal splenorenal shunt (Warren shunt) was performed to reduce the LSPH. Despite anticoagulation with low molecular weight heparin and antithrombin substitution, endoluminal thrombosis led to a complete Warren shunt occlusion, aggravating the severe splenomegaly and pancytopenia. Finally, a partial spleen embolization (PSE) was performed. In the postinterventional course, leukocyte and platelet counts increased rapidly and the patient showed no further bleeding episodes. Overall, this complex course demonstrates the need for individual assessment of multimodal treatment options in non-cirrhotic portal hypertension. This young patient required triple modality porto-systemic pressure reduction (TIPSS, Warren shunt, PSE) and involved finely balanced anticoagulation and bleeding control.<\/jats:p>","DOI":"10.1055\/a-1330-9827","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T09:03:13Z","timestamp":1610442193000},"page":"43-49","source":"Crossref","is-referenced-by-count":4,"title":["Multidisciplinary approach to the complex treatment for non-cirrhotic portal hypertension \u2013 case-report-based discussion"],"prefix":"10.1055","volume":"59","author":[{"given":"Simon J.","family":"Gairing","sequence":"additional","affiliation":[{"name":"I. Medizinische Klinik und Poliklinik, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman","family":"Kloeckner","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Diagnostische und Interventionelle Radiologie, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Pitton","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Diagnostische und Interventionelle Radiologie, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Baumgart","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral- und Transplantationschirurgie, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charis","family":"von Auer-Wegener","sequence":"additional","affiliation":[{"name":"III. Medizinische Klinik und Poliklinik, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hauke","family":"Lang","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral- und Transplantationschirurgie, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R.","family":"Galle","sequence":"additional","affiliation":[{"name":"I. Medizinische Klinik und Poliklinik, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedrich","family":"Foerster","sequence":"additional","affiliation":[{"name":"I. Medizinische Klinik und Poliklinik, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"I. Medizinische Klinik und Poliklinik, Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1053\/j.gastro.2019.01.265","article-title":"Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis","volume":"156","author":"N M Intagliata","year":"2019","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/hep.23259","article-title":"Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study","volume":"51","author":"A Plessier","year":"2010","journal-title":"Hepatology"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/MBC.0000000000000901","article-title":"The utility of thrombophilia testing in 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