Portal Vein Thrombosis after Splenectomy

Abstract

Backgroundand Aim of the work: Splenectomy is a common operation but it carries the danger of many postoperative complications. One of the most important complications is the portal vein thrombosis (PVT), which may be fatal due to development of bowel ischemia and severe portal hypertension. Due to the effect of hypobaric hypoxia and higher liability for thrombosis encountered in high altitude areas, PVT may represent an actual problem in Taif province. The aim of this retrospective study is to detect the incidence, pattern of presentation, laboratory, radiological and results of treatment of cases of PVT following splenectomy. Methods: In this study, we reviewed all cases of splenectomy performed in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2007 to January 2012. Cases of PVT following splenectomy were analyzed for incidence, pattern of presentation, laboratory, radiological and results of treatment. Results: This study involved 50 patients (40 males and 10 females) admitted in the surgical department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2007 to January 2012. Eight cases of Portal vein thrombosis (16%) out of 50 splenectomies were identified. These 8 patients included: 4/10 of the patients (40%) suffering from myeloproliferative (MP), 3 of them (75%) had spleen weight greater than 3,000 g, 3/12 (25%) of the hemolytic anemia patients, and 1/10 of the patients (10%) operated upon for Hypersplenism. All patients had splenomegaly with mean weight of 1540 Gms (range 460 to 3850 g). Presenting symptoms included; anorexia in 7/8 cases (87.5%), abdominal pain in 6 (75%), and in all cases there was elevation in D-Dimer level, leukocyte and platelet counts. All diagnoses were made by contrast-enhanced computed tomography scan, and anticoagulation was initiated immediately. One/8 patients (12.5%) died from progressive liver cell failure; the others are alive with no clinical sequalae at a mean follow up of 27 months. CONCLUSIONS: PVT is a relatively common complication of splenectomy in patients with Splenomegaly, especially in Taif and related districts in which there is already a higher incidence of thrombotic disorders. The surgeon has to be with high index of suspicion, for early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation for successful outcome.