Portal-vein thrombosis after surgery and chemotherapy for Stage III gastric cancer — Case 1

What happened, in summary

A 48-year-old woman was admitted with upper abdominal pain, major weight loss and vomiting blood. Endoscopy found a depressed lesion in the body of the stomach, and CT showed regional lymph-node involvement without distant organ metastases. She underwent laparoscopic partial gastrectomy with Roux-en-Y reconstruction. Surgical pathology showed invasion through the stomach wall and regional lymph-node involvement, and the cancer was classified as Stage III.

Five days after surgery she developed a high fever. Imaging suggested a small anastomotic leak with abdominal infection, which improved with antibiotics, and she was discharged on postoperative day 15. Postoperative SOX chemotherapy with S-1 plus oxaliplatin was then started.

After the first chemotherapy course she again developed a high fever with chills, fatigue and loss of appetite. Contrast CT showed thrombosis involving the main portal vein and right hepatic vein. Chemotherapy was stopped, and she was treated with anticoagulation and antibiotics. Two weeks later the fever had resolved and imaging showed a smaller clot with cavernous transformation of the portal vein. She was discharged on oral anticoagulation. During 6 months of follow-up, no hepatic decompensation or liver cirrhosis was observed.