Portal vein thrombosis after splenectomy in pediatric hematologic disease: risk factors, clinical features, and outcome

The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

“…All in all, 31/67 (46.3%) of patients with positive imaging findings developed symptoms (fever, abdominal pain) which could be related to SPVT. The incidence of only symptomatic SPVT was evaluated in eight retrospective cohort studies, three after OS [19][20][21] and two after LS, 22,23 in three other studies OS and LS were performed in the same study, but OS and LS evaluated separately. 5,24,25 The incidence of symptomatic SPVT in these studies was 2.6% with a range of 0.35% to 13% (Table 2).…”

“…In the majority of cases in whom a follow-up investigation was performed (n=90) 5,9,11,12,[15][16][17][20][21][23][24][25]28,33 there was a documented complete (57/90, 63.3%) or at least partial resolution (13.3 %) of the thrombus. However, in 7.7% the thrombus persisted and in 15.5% cavernoma or portal hypertension were documented.…”

Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

“…Although the exact mechanisms of PV-SMV thrombosis formation after splenectomy remain unclear, altered platelet function as well as transient thrombocytosis after splenectomy, a decrease in portal blood flow and pressure, and stasis of blood in the stump of the splenic vein appear to predispose to PV-SMV thrombosis [6,18] . Ikeda et al [4] reported that patients with PV-SMV thrombosis after splenectomy had a significantly heavier splenic weight than those without PV-SMV thrombosis, suggesting that a large splenic mass is a possible risk factor for postsplenectomy PV-SMV thrombosis.…”

“…Although many patients with PV and SMV thrombosis may be asymptomatic, the consequences of these thromboses can be severe, and include mesenteric ischemia and variceal bleeding, with a mortality rate of 5%-37% [2] . There are no uniform protocols for the effective treatment of PV-SMV thrombosis following splenectomy, including duration of anticoagulation therapy and the potential effectiveness of prophylactic perioperative antiplatelet agents [6][7][8][9] . However, to avoid lethal complications, appropriate treatment should be performed as soon as possible, especially in patients with SMV involvement [4,6] .…”

“…There are no uniform protocols for the effective treatment of PV-SMV thrombosis following splenectomy, including duration of anticoagulation therapy and the potential effectiveness of prophylactic perioperative antiplatelet agents [6][7][8][9] . However, to avoid lethal complications, appropriate treatment should be performed as soon as possible, especially in patients with SMV involvement [4,6] . Recently, endovascular interventional techniques have been recognized as promising alternatives for the treatment of PV-SMV thrombosis.…”