Delayed severe variceal bleeding in a child with chronic portal vein thrombosis following neonatal hepatic abscesses: A case report and structured narrative review

Neonatal hepatic abscess may be accompanied by portal venous complications, particularly in infants with additional thrombotic risk factors. We report a 27-month-old boy born prematurely at 33 weeks of gestation whose early course was complicated by methicillin-resistant Staphylococcus aureus sepsis, umbilical venous catheterization, multiple hepatic abscesses, and chronic portal vein thrombosis (PVT) with cavernous transformation. The hepatic lesions subsequently resolved with antimicrobial therapy, whereas portal venous disease persisted. At 27 months, he presented with large-volume hematemesis and hematochezia, a pre-transfusion hemoglobin level of 3 g/dL, and hypovolemic shock. Endoscopy demonstrated grade III esophageal varices and portal hypertensive gastropathy, and he was treated with resuscitation, blood-product transfusion, octreotide, and endoscopic variceal ligation, followed by propranolol for secondary prophylaxis. No recurrent gastrointestinal bleeding occurred before discharge. A structured narrative literature search of PubMed/MEDLINE, Europe PMC, and OpenAlex identified nine directly relevant published studies or reports describing neonatal hepatic abscess associated with PVT, cavernous transformation, extrahepatic portal vein obstruction, portal hypertension, or later variceal bleeding. This case illustrates that portal venous disease may persist after resolution of neonatal hepatic infection and present later with severe portal-hypertensive bleeding. Longitudinal surveillance is warranted when portal venous abnormalities are identified, while prospective multicenter studies are needed to better define natural history, predictors of progression, and optimal follow-up strategies.