Portal vein thrombosis following splenectomy

Abstract

AIMS: The aim of this study was to assess the risk and progress of portal vein thrombosis (PVT) after splenectomy. METHODS: A prospective study was conducted in which two groups of patients were compared; each group comprised 50 patients (27 men, 23 women). Patients in the splenectomy group were of mean age 46.3 years. A second group of patients (mean age 48.5 years) had upper abdominal surgery other than splenectomy. All patients were examined before and 2 weeks after operation by duplex Doppler ultrasonography (DDUS) of the portal system. Those who developed PVT were followed up by DDUS at 6 and 12 months. RESULTS: PVT developed in 10 per cent of patients who underwent splenectomy. The portal vein was completely occluded by thrombus in 4 per cent and partially occluded in 6 per cent of patients. Symptoms and signs attributable to PVT (abdominal pain, diarrhoea, nausea, vomiting and mild fever) were found in 80 per cent of those who developed this complication. Follow-up of such patients revealed complete recanalization of portal vein in 40 per cent and partial recanalization in 60 per cent after treatment with antibiotics and long-term anticoagulation therapy. No patient who underwent upper abdominal surgery (other than splenectomy) developed PVT afterwards. CONCLUSIONS: Splenectomy (compared with other upper abdominal surgery) is followed by PVT in 10 per cent of patients but can be treated successfully.

Thromboembolic complications after splenectomy for hematologic diseases

“…In an American investigation carried out with 50 splenectomized patients whose underlying disease was not further specified, 5 of 50 patients (10%) were found to develop PVT that was then successfully treated with anticoagulation [7]. In an Italian report on patients undergoing splenectomy for treatment of thalassemia, an incidence of TE as high as 29% was seen [8].…”

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

“…The incidence of SPVT after splenectomy was evaluated prospectively with different imaging methods in ten studies, five after OS [8][9][10][11]15 and five after LS. 12,13,16,17,18 Contrast-enhanced computerized tomography (CT) was used by two studies of the same authors 8,17 and color Doppler imaging in the remaining studies.…”

“…8,17 Another explanation for the above-mentioned discrepancies may be the time points of screening, which were quite variable. 9,[11][12][13]15 The definition of risk factors is important for the choice of intensity and duration of postoperative antithrombotic prophylaxis. Generally, three groups of risk factors have to be considered: (i) preoperative general clinical or laboratory risk factors, such as age, obesity, previous thrombosis; (ii) the underlying disease (in particular malignant disease); and (iii) factors related to the surgical intervention itself (duration, open or laparascopic surgery).…”

“…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

“…The incidence of this type of complication ranges from 1.6% to 11% in some series [3] and from 6.3% to 10% in others [4,5] . 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] .…”