Liver & intrahepatic bile ducts

Vascular disorders

Portal vein obstruction

Topic Completed: 11 January 2021

Minor changes: 18 January 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Portal vein obstruction[TI] liver pathology

Raul S. Gonzalez, M.D.
Page views in 2020: 837
Page views in 2021 to date: 1,010
Cite this page: Gonzalez R. Portal vein obstruction. website. Accessed December 8th, 2021.
Definition / general
  • Blockage of blood flow through the portal vein into the liver
Essential features
  • Malignant and nonmalignant processes may cause portal vein obstruction
  • Portal hypertension commonly results
  • Biliary abnormalities may also occur
  • Portal vein obstruction leading to splenomegaly and anemia is termed "Banti syndrome"
  • Portal vein obstruction may cause a sclerosing cholangitis-like clinical picture termed "portal biliopathy" (World J Gastroenterol 2012;18:6177, Gut 1992;33:272
  • Relatively rare
  • Hepatic artery buffer response allows for increased arterial flow to liver when portal vein is obstructed
  • Prothrombotic disorders, tumor thrombus, cirrhosis, pancreatitis, various infections (e.g. schistosomiasis) (BMC Gastroenterol 2007;7:34)
  • Intraabdominal infection and appendicitis are common causes in children
  • May be idiopathic
Clinical features
  • Signs / symptoms:
    • Abdominal pain
    • Ascites (massive, intractable)
    • Portal hypertension
    • Bowel infarction
Radiology description
Radiology images

Images hosted on other servers:

Pancreatic mass and portal vein thrombosis

Case reports
Gross images

Images hosted on other servers:

Tumor thrombus causing portal vein obstruction

Sample pathology report
  • Liver, native, orthotopic transplantation:
    • Liver with portal vein thrombosis and patchy sinusoidal dilation and zone 3 necrosis (see comment)
    • Comment: The parenchymal findings are mild, as is often the case with portal vein obstruction. Trichrome and iron stains are unremarkable.
Board review style question #1
A patient develops portal vein thrombosis secondary to appendicitis. Based on this information, which of the following is most likely true regarding the patient?

  1. Has an allograft liver
  2. Has situs inversus
  3. Has von Willebrand disease
  4. Is a child
  5. Is a woman
Board review style answer #1
D. Is a child

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Reference: Portal vein obstruction
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