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Portal cavernoma complicated with splenic aneurysms during antiphospholipid syndrome (case report) Volume 29, issue 3, May-June 2017

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Authors
1 Hôpital militaire régional universitaire de Constantine, Service d’imagerie médicale, Ali Mendjili El Khroub, 25000 Constantine, Algérie
2 Hôpital militaire régional universitaire de Constantine, Service de gastroentérologie et hépatologie, Ali Mendjili El Khroub, 25000 Constantine, Algérie
* Tirés à part

The discovery of a portal cavernoma following a high digestive hemorrhage in a patient with a history of abortion iterative, is the witness of a chronic evolution of a portal thrombosis and it must impose an etiological investigation of a prothrombotic affection, unrecognized, in this case the antiphospholipid syndrome (Hughes’ syndrome). Our observation describes the infra-hepatic obstacle (portal cavernoma), appreciates the extent of the porto-systemic collateral and objectives the multiple hilar and intra-spleen aneurysms, following a chronic and ancient thrombosis of the extra-hepatic portal system. The antiphospholipid syndrome is an acquired immune disorder with thrombogenic potential of polymorphic expression, which should be systematically considered first in any context of portal vein thrombosis, in a young woman with a history of abortions. From a therapeutic point of view, the stage of chronic portal thrombosis during the antiphospholipid syndrome impose prolonged anticoagulation, but this is far from being codified, clashing paradoxically with the potential haemorrhagic risks linked to portal hypertension and the many hyper-rate splenic aneurysms that can rupture. Splenic embolization with obturation and/or exclusion of aneurysms, as well as portal reperfusion surgery are theoretically justified, reserved for highly specialized centers.