Abstract
<i>Background:</i> Post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients’ lives. Different variables were identified as risk factors for PS-PVT in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients. <i>Patients and methods:</i> Sixty cirrhotic patients of Child class A submitted to open splenectomy were observed, both clinically and by Duplex ultrasound (US) examination, for the development of PS-PVT. <i>Results:</i> Overall, 17 patients (28.3%) developed PS-PVT at a median interval of 4.5 days (21 hours-7 days) post-splenectomy. Univariate analysis showed that lower preoperative platelet count (P<0.0460) and white blood cell (WBC) count (P<0.0001) and wider splenic vein diameter (SVD) (P<0.0001) correlated with PS-PVT. Multivariate analysis identified lower preoperative WBC count [odds ratio (OR): 0.651, 95% confidence interval (CI): 0.245-0.893, P<0.005] and wider SVD (OR: 2.383, 95% CI: 1.558-3.646., P<0.001) as independent risk factors of PS-PVT. While 16 out of the 17 patients (94%) who had these 2 risk factors developed PS-PVT, only 1 out of the 43 patients (2.3%) who didn’t have the same risk factors developed thrombosis. All 17 patients had complete resolution of their thrombosis on anticoagulation therapy within 3-6 months without complications or mortality. <i>Conclusion:</i> PVT is a common complication of splenectomy in cirrhotic patients. Patients with low WBC count and wide SVD are highly susceptible to develop this complication mandating close observation from the 1<sup>st</sup> PO day and immediate anticoagulation after diagnosis.
Highlights
Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world [1, 2] reaching 22% in those aged 55-59 years in 2015 [3]
Cirrhotic patients of Child class A submitted to open splenectomy for symptomatic splenomegaly, 2ry hypersplenism or thrombocytopenia (Platelet count
The study population included 60 patients who were divided into 2 groups; group (A) included patients who developed Post-splenectomy portal venous thrombosis (PS-PVT) and group (B) included patients who did not
Summary
Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world [1, 2] reaching 22% in those aged 55-59 years in 2015 [3]. 14], post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients’ lives including upper gastrointestinal bleeding, ischemic bowel necrosis, liver cell failure and refractory ascites [15, 16]. Since symptoms, such as abdominal pain and fever are non-specific and PS-PVT can develop without any symptoms, identification of high-risk patients is essential to allow starting anticoagulation immediately once the diagnosis is made [17, 18]. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients. Patients with low WBC count and wide SVD are highly susceptible to develop this complication mandating close observation from the 1st PO day and immediate anticoagulation after diagnosis
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