Background
Optimal modalities for diagnosis, treatment, and surveillance of portal or splenic
vein thrombosis have not yet been defined. The present retrospective study aimed to
investigate the role of computed tomography performed systematically before and after
laparoscopic splenectomy to assess the incidence of portal or splenic vein thrombosis,
predictors, and outcomes.
Methods
Computed tomography scans were obtained from 170 patients undergoing elective laparoscopic
splenectomy between 2005 and 2015. Pre- and postoperative splenic vein diameter was
measured at the splenoportal junction and at a distance of 2, 4, 6 cm from it. Univariate
and multivariate analyses were used to identify portal or splenic vein thrombosis
risk factors and predictors of treatment outcome.
Results
Overall, 68.2% of patients had benign hematologic diseases; 64.1% showed splenomegaly.
Portal or splenic vein thrombosis occurred in 53.5% of patients (91/170), of whom
49.5% were asymptomatic. Preoperative splenic vein diameter measurements at 2, 4,
and 6 cm from the splenoportal junction were significantly greater in portal or splenic
vein thrombosis patients than in no-portal or splenic vein thrombosis patients. Patients
with splenic vein diameter ≥8 mm at all measured sites had a greater risk of developing
portal or splenic vein thrombosis (P = .009; odds ratio, 2.57; 95% confidence interval, 1.26–5.23). The majority of thromboses
involved the distal splenic vein (45.1%, 41/91), and 41.7% of patients had thromboses
located in multiple sites. Fully 71.4% showed complete resolution of portal or splenic
vein thrombosis. Thrombus location at a single site predicted a favorable treatment
outcome (P < .0001).
Conclusion
Portal or splenic vein thrombosis is a frequent complication of splenectomy that occurs
asymptomatically in half of cases. Computed tomography could have an important role
in identifying patients at risk of developing portal or splenic vein thrombosis as
well as in predicting portal or splenic vein thrombosis resolution.
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References
- Portal vein thrombosis after elective splenectomy. An underappreciated, potentially lethal syndrome.Arch Surg. 1993; 128 (discussion 569-70): 565-569
- Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy.Surgery. 2009; 145 (discussion 465-6): 457-464
- Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy.Surg Endosc. 2016; 30: 2119-2126
- Rev Med Interne. 2017; 38: 3-7
- Thrombosis of the splenoportal axis after splenectomy.Langenbecks Arch Surg. 2006; 391: 483-488
- Portal vein thrombosis after splenectomy.Am J Surg. 2002; 184 (discussion 635-6): 631-635
- Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment.Am J Surg. 2007; 193: 21-25
- Thrombosis in the portal venous system after elective laparoscopic splenectomy.Surg Endosc. 2004; 18: 1140-1143
- Recommended timing for surveillance ultrasonography to diagnose portal splenic vein thrombosis after laparoscopic splenectomy.Surg Endosc. 2010; 24: 1670-1678
- Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging.World J Surg. 1998; 22: 1082-1086
- High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan.Ann Surg. 2005; 241: 208-216
- The postoperative splenic/portal vein thrombosis after splenectomy and its prevention–an unresolved issue.Haematologica. 2008; 93: 1227-1232
- Solitary splenic metastasis from nasopharyngeal carcinoma: a case report and systematic review of the literature.World J Surg Oncol. 2016; 14: 184
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Relaxing the rule of ten events per variable in logistic and Cox regression.Am J Epidemiol. 2007; 165: 710-718
- Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy.Can J Surg. 2011; 54: 227-231
- Portal vein thrombosis is a common complication following splenectomy in patients with malignant haematological diseases.Eur J Haematol. 2006; 77: 203-209
- Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins.Arch Surg. 2006; 141: 663-669
- Laparoscopic splenectomy in the management of benign and malignant hematologic diseases.JSLS. 2006; 10: 199-205
- Portal vein thrombosis after laparoscopic splenectomy in benign hematologic diseases.J Laparoendosc Adv Surg Tech A. 2007; 17: 448-454
- Mesenteric venous thrombosis: diagnosis and noninvasive imaging.Radiographics. 2002; 22: 527-541
- Thrombosis of the portal venous system after splenectomy for pediatric hematologic disease.J Pediatr Surg. 1993; 28: 1109-1112
- Postoperative portal vein thrombosis in patients with hepatosplenic mansonic schistosomiasis: relationship with intraoperative portal pressure and flow. A prospective study.Hepatogastroenterol. 2005; 52: 1529-1533
- Laparoscopic splenectomy is a better surgical approach for spleen-relevant disorders: a comprehensive meta-analysis based on 15-year literature.Surg Endosc. 2016; 30: 4575-4588
- Reemergence of Splenectomy for ITP Second-line Treatment?.Ann Surg. 2016; 264: 772-777
- Technical standardization of laparoscopic splenectomy: experience with 105 cases.Surg Endosc. 2002; 16: 972-974
Article info
Publication history
Published online: September 14, 2017
Accepted:
July 21,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
