Portal vein thrombi after restorative proctocolectomy.
BACKGROUND
Restorative proctocolectomy (RP) has been the surgical procedure of choice for surgical management of mucosal ulcerative colitis since 1978. This study was undertaken to investigate the clinical presentation and implications of portal vein thrombi (PVT).


METHODS
We reviewed all patients undergoing RP in our institution in the 4 years from January 1997 to December 2000. As the diagnosis of PVT was made on computed tomography (CT) scan in all cases, we confined our incidence estimate to those patients having an abdominal CT scan postoperatively. All scans were reviewed by an experienced radiologist. Patient demographics, symptoms, and clinical course were recorded.


RESULTS
A total of 702 patients underwent RP, of whom 94 had a CT scan within the postoperative period. PVT was diagnosed in 42 of the 94 patients (45%). PVT was diagnosed at initial reading of the scan in 11 patients, and on review in 31. The indications for CT scan included abdominal pain, fever, leukocytosis, and delayed bowel function. Septic complications of RP caused these symptoms and signs in 45 patients, 20 of whom had PVT. Twenty-two patients were found to have had PVT without evidence of any septic source.


CONCLUSIONS
PVT can be found in a high proportion of patients undergoing abdominal CT scan after RP. It is often associated with pain, fever, nausea vomiting, tenderness, and leukocytosis. This study shows that PVT subtle enough to go undiagnosed has no serious consequences, even when not treated. Also, patients treated with anticoagulation recover completely.
Remzi
Feza H
FH
Departments of Colorectal Surgery; Radiology; and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. remzif@ccf.org
Fazio
Victor W
VW
Oncel
Mustafa
M
Baker
Mark E
ME
Church
James M
JM
Ooi
Boon S
BS
Connor
Jason T
JT
Preen
Miriam
M
Einstein
David
D
D000328:Adult; D015331:Cohort Studies; D003108:Colonic Diseases / Q000145:classification / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011169:Portal Vein; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*