Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

Abstract

Despite the high incidence of PVT in IPH patients postsplenectomy, it may not be related to their gastrointestinal bleeding or prognosis.

Clinical features of idiopathic portal hypertension in China: A retrospective study of 338 patients and literature review

“…The median white blood cell count and hemoglobin in female patients were significantly lower than those in male patients; this may be related with the older age at onset and longer duration of hypersplenism in female patients. Liver function of most IPH patients tends to remain normal or near normal in general . In our cohort, the median level and abnormal percentages of aminotransferase and bilirubin in male patients were significantly higher than those in female patients.…”

“…Subsequently, the thrombosis typically extends to the splenic and superior mesenteric veins or the intrahepatic portal branches. 44 In our cohort, 16.5% (32/ 194) of patients for whom imaging records were available showed signs of PVT, and all of these patients had normal platelet counts. With passage of time, the portal vein can be recanalized, and the collateral circulation can be formed, which eventually leads to CTPV.…”

“…Notably, 51.8% patients in our cohort for whom ultrasonic records were available showed widening of portal vein, which is liable to decrease flow velocity, contribute to the formation of blood clots, and further the PVT on the luminal surface of the portal vein. Subsequently, the thrombosis typically extends to the splenic and superior mesenteric veins or the intrahepatic portal branches . In our cohort, 16.5% (32/194) of patients for whom imaging records were available showed signs of PVT, and all of these patients had normal platelet counts.…”

Diagnosis and treatment guidelines for aberrant portal hemodynamics

“…When symptoms associated with splenomegaly (abdominal pain and compression) or a tendency to bleed and severely decreased blood cells (at least one of the following: platelets, ≤5 × 10 4 ; white blood cells, ≤3000; and red blood cells, ≤300 × 10 4 ) associated with splenomegaly, partial splenic embolization or splenectomy should be considered …”

“…When symptoms associated with splenomegaly (abdominal pain and compression) or a tendency to bleed and severely decreased blood cells (at least one of the following: platelets, ≤5 × 10 4 ; white blood cells, ≤3000; and red blood cells, ≤300 × 10 4 ) associated with splenomegaly, partial splenic embolization or splenectomy should be considered. 19,106,[136][137][138][139][146][147][148]167,168,[180][181][182][183][184][185][186][187][188][189][190][191][192][193] Guidelines for treatment of stenosis and obstruction in BCS Obstruction or stenosis of the main trunk of the hepatic vein or the hepatic segment of the inferior vena cava should be treated by recanalization or dilatation with a catheter, stent placement, surgery to directly eliminate the obstruction and stenosis, or a shunt operation between the upper and lower sites of obstruction and stenosis of the vena cava. 131,[194][195][196][197][198][199][200][201][202][203][204][205][206] In acute cases with thrombus obstruction up to the peripheral part of the hepatic vein, the liver resection and peripheral hepatic vein-right atrium anastomosis may be an option.…”