Portal-vein thrombosis after surgery and chemotherapy for Stage III gastric cancer — Case 2

What happened, in summary

A 66-year-old woman developed upper abdominal pain, heartburn and vomiting. Endoscopy and CT suggested an infiltrative gastric cancer, and biopsy showed adenocarcinoma. She underwent laparoscopic partial gastrectomy with Roux-en-Y reconstruction. Pathology showed poorly differentiated adenocarcinoma invading the serosa with regional lymph-node involvement, classified as Stage III.

Her initial postoperative recovery was uncomplicated, although CT before discharge showed a small fluid collection near the stomach. She went home on postoperative day 12, and 3 weeks later the collection had disappeared. SOX chemotherapy with S-1 plus oxaliplatin was then started.

Thirteen days after beginning chemotherapy, she suddenly developed a high fever with chills and fatigue. CT showed thrombosis involving the right hepatic vein together with a small amount of ascites. She was treated with antibiotics and heparin. Within 6 days the fever resolved and laboratory results improved, allowing discharge on oral rivaroxaban. Two weeks later ultrasound showed partial reopening of the thrombosed vessels and cavernous transformation around the portal vein.

Follow-up was still ongoing at 2 months, with no hepatic decompensation or liver cirrhosis identified.