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Spontaneous portomesenteric thrombosis in a non-cirrhotic patient with SARS-CoV-2 infection
  1. Kushala WM Abeysekera1,
  2. Hedvig Karteszi2,
  3. Amanda Clark3 and
  4. Fiona H Gordon1
  1. 1Department of Liver Medicine, Bristol Royal Infirmary, Bristol, UK
  2. 2Department of Radiology, Bristol Royal Infirmary, Bristol, UK
  3. 3Bristol Haematology and Oncology Centre, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Dr Kushala WM Abeysekera; k.abeysekera{at}


Intra-abdominal thromboses are a poorly characterised thrombotic complication of COVID-19 and are illustrated in this case. A 42-year-old man with chronic hepatitis B (undetectable viral load, FibroScan 7.4 kPa) developed fever and cough in March 2020. 14 days later, he developed right upper quadrant pain. After being discharged with reassurance, he re-presented with worsening pain on symptom day 25. Subsequent abdominal ultrasound suggested portal vein thrombosis. CT of the abdomen confirmed portal and mid-superior mesenteric vein thromboses. Concurrent CT of the chest suggested COVID-19 infection. While reverse transcription PCR was negative, subsequent antibody serology was positive. Thrombophilia screen excluded inherited and acquired thrombophilia. Having been commenced on apixaban 5 mg two times per day, he is currently asymptomatic. This is the first case of COVID-19-related portomesenteric thrombosis described in the UK. A recent meta-analysis suggests 9.2% of COVID-19 cases develop abdominal pain. Threshold for performing abdominal imaging must be lower to avoid this reversible complication.

  • liver disease
  • hepatitis B
  • portal hypertension
  • radiology

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  • Contributors KWMA performed literature search and wrote the manuscript. HK reviewed the imaging and the manuscript. AC reviewed the thrombophilia screen and the manuscript. FHG oversaw the project and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.