• Hong Jiang, Shengduo He, and Huahong Wang.
• Department of Gastroenterology, Peking University First Hospital, Beijing, China.
• Medicine (Baltimore). 2023 Sep 15; 102 (37): e35098e35098.

RationaleVenous thromboembolism is one of the common complications of inflammatory bowel disease (IBD), which is a significant health problem worldwide. Factors such as inflammation, medications, and abdominal surgery, contribute to the increased risk of venous thromboembolism in patients with IBD. Cavernous transformation of the portal vein (CTPV) is a relatively rare complications of IBD. Subsequent portal hypertension could be fatal and the clinical treatment is difficult. Thus, early prevention is very crucial.Patient ConcernsA 55-year-old man presented to our department with asthenia, hematemesis, and diarrhea. He was diagnosed with Crohn disease for 9 years. Two years ago, He suffered intestinal perforation and received enterectomy and ileostomy. And, anticoagulants were not given during perioperative period and after surgery because of the history of gastrointestinal bleeding.DiagnosesThe patient was given endoscopy inspection showing the varices of esophagus and gastric fundus near cardia. Contrast enhancement CT scan showed portal hypertension, CTPV, gastroesophageal varices, and splenomegaly. Then percutaneous transhepatic portography was performed to make a clear diagnosis.InterventionsConcerned about the risk of surgery, he refused surgical shunting. Conservative treatment was recommended due to technical difficulties instead of interventional therapy.OutcomesAnd after a period of fasting, blood transfusion, and parenteral nutrition treatment, the patient did not experience any further vomiting or hematemesis.LessonsEarly identification and treatment of CTPV is difficult. Prevention such as early application of anticoagulant is necessary for patients with IBD undergoing surgery, particularly with simultaneous stoma formation. For IBD patients who are not suitable for anticoagulant therapy, postoperative follow-up monitoring should be more frequent and monitoring time should be extended.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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