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I read with interest the article by Janssen et al (Gut 2001;49:720–4) regarding the aetiology and determinants of survival of extrahepatic portal vein thrombosis (EPVT). Among others, this retrospective study investigated the systemic risk factors for EPVT. We would like to add hyperhomocysteinaemia as a relatively new, not yet mentioned, risk factor.1–3 This is illustrated by a recent case in our clinic.
A 54 year old woman was hospitalised because of worsening of upper abdominal pain which started two weeks before admission and was continuously present. Her personal and family history for thromboembolic processes was uneventful and she did not smoke. She did not use vitamin supplements. One day prior to admission she was using the progesterone norethisterone (Primolut N) because of vaginal blood loss.
Combined portal-splenic vein thrombosis was diagnosed using colour Doppler ultrasonography and computed tomography. There were already some venous collaterals …