Portal vein thrombosis diagnosis, treatment, and medical malpractice

As a Houston, Texas medical malpractice attorney, I have handled many cases involving complications after surgery that led to devastating patient outcomes when they went undiagnosed and untreated for too long.

A recent case that went to trial in Harris County, Texas dealt with one such complication, portal vein thrombosis. The case is styled Kara Nguyen v. Ziad Amr., M.D., Anna Belcheva, M.D., Jorge Leiva, M.D., Andre Arash Lighvani, M.D., and The Methodist Hospital; Cause No. 2014-17076, In the 234th District Court of Harris County, Texas. The presiding judge of that court is my former colleague, The Honorable Wesley Ward.

Portal vein thrombosis

The portal vein is an important blood vessel that carries blood from abdominal organs, including the gallbladder, pancreas, spleen, and gastrointestinal (GI) tract to the liver. It provides approximately 75% of blood flow to the liver.

Portal vein thrombosis is a dangerous condition where the portal vein is blocked or narrowed by a blood clot. Left untreated, it can cause a buildup and pressure called portal hypertension, which can be life-threatening.

The Nguyen lawsuit

Kara Nguyen, a 22-year-old woman, went to Houston Methodist Willowbrook Hospital for surgery because of hemolytic anemia. Our firm has handled a number of cases against this hospital, including one that is currently pending in Harris County.

Jorge Leiva, M.D. performed surgery on Nguyen to remove her spleen and gallbladder.

She was discharged from the hospital and then re-admitted later because of fever and the possibility of an internal infection and abscess. Ziad Amr, M.D., a colleague of Dr. Leiva, admitted her to the hospital on this occasion.

I am very familiar with Dr. Leiva and Dr. Amr based on medical malpractice lawsuits that I have filed against them on behalf of other patients. In different cases that I have handled against these two general surgeons, one surgeon performed the surgery, while the other was substantially involved in the follow-up care. This is similar to what happened in the Nguyen case. In these instances, good communication between the general surgeons is important for patient safety.

Nguyen’s general surgery expert was critical of the general surgeons for inadequate communication and for not paying attention to ancillary testing. For example, an abdominal CT scan showed a completely occluded thrombus (clot) of the splenic vein and partial occlusion of the main portal and right and left portal veins. Lab work also gave signs that something was wrong. Nguyen had elevated platelet (clotting factor) and D-dimer levels. The expert concluded that, despite these test results, both Dr. Leiva and Dr. Amr fell beneath the standard of care by failing to diagnose and treat the patient.

The plaintiff’s surgical expert contended that the physicians involved in Nguyen’s care should have recognized that the patient had a potential life-threatening issue with a hypercoagulable state and thrombosis of the portal vein. The expert felt that this should have led to a consultation with a hematologist (blood specialist) to develop a treatment plan.

The surgical expert concluded that, absent appropriate surgical and medical intervention, the patient’s portal vein thrombosis progressed into the right and left hepatic veins and superior mesenteric vein. The expert believed that these further complications could have been avoided with appropriate care. Instead, the patient was left with failure of her small bowel and the potential for severe damage to her liver.

In addition to this testimony, the plaintiff’s hematology expert shared his opinion that there was a 12-day period during which the patient’s portal vein thrombosis could have been dissolved or prevented from further extending if appropriate treatment had been initiated. These treatments included things like anticoagulation with unfractionated heparin or low molecular weight heparin, trans-jugular catheterization of occluded veins, local thrombolytic infusion directly into the area of the thrombosis or into the portosystemic artery, stent implantation, or mechanical thrombectomy.

The jury verdict

The jury found Dr. Lighvani, Dr. Amr, and Dr. Belcheva negligent, and found Dr. Leiva not negligent.

I am pleased that the Harris County jury found in favor of Nguyen, and awarded $450,000 for past medical expenses, $3.8 million for future medical expenses, $225,000 for future loss of earning capacity, $200,000 for past physical pain and mental anguish, $750,000 for future pain and mental anguish, $400,000 for past physical impairment, and $775,000 for future physical impairment.

Under the rules mandated by Texas tort reform, some of these substantial damages would be reduced upon entry of judgment by the trial court. For example, the separate awards for past and future physical pain, mental anguish, and physical impairment would be reduced from a total of $2.35 million to the statutory cap of $250,000. In addition, the court would have to decide on how the $3.8 million award for future medical expenses would be paid. What is certain, though, is that after a defense objection, the court would be unable award it in a lump sum. In my experiences, the parties in many cases like this settle after a jury verdict of this nature.

We are here to help

If you or someone you love has been seriously injured by delayed diagnosis or treatment of a surgical complication, such as portal vein thrombosis, our experienced medical negligence attorneys can help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.