High incidence of thrombosis of the portal venous system after laparoscopic splenectomy: a prospective study with contrast-enhanced CT scan.
OBJECTIVE
The aims of this prospective study were to investigate the true incidence of portal or splenic vein thrombosis (PSVT) after elective laparoscopic splenectomy using contrast-enhanced computed tomography (CT) scan, and outcome of anticoagulant therapy for PSVT.


BACKGROUND
Although rare, thrombosis of the portal venous system is considered a possible cause of death after splenectomy. The reported incidence of ultrasonographically detected PSVT after elective open splenectomy ranges from 6.3% to 10%.


METHODS
Twenty-two patients underwent laparoscopic splenectomy (LS group), and 21 patients underwent open splenectomy (OS group). Preoperative and postoperative helical CT with contrast were obtained in all patients, and the extent of thrombosis was investigated. Prothrombotic disorder was also determined.


RESULTS
PSVT occurred in 12 (55%) patients of the LS group, but in only 4 (19%) of the OS group. The difference was significant (P = 0.03). Clinical symptoms appeared in 4 of the 12 LS patients. Thrombosis occurred in the intrahepatic portal vein (n = 9), extrahepatic portal vein (n = 2), mesenteric veins (n = 1), proximal splenic vein (n = 4), and distal splenic vein (n = 8). Prothrombotic disorder was diagnosed in 1 patient. Anticoagulant therapy was initiated once the diagnosis was established, and complete recanalization, except for distal splenic vein, was observed without any adverse event. Patients with splenomegaly were at high risk of PSVT.


CONCLUSIONS
PSVT is a more frequent complication of laparoscopic splenectomy than previously reported but can be treated safely following early detection by CT with contrast.
Ikeda
Masataka
M
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Suita, Japan. mikeda@surg2.med.osaka-u.ac.jp
Sekimoto
Mitsugu
M
Takiguchi
Shuji
S
Kubota
Masaru
M
Ikenaga
Masakazu
M
Yamamoto
Hirofumi
H
Fujiwara
Yoshiyuki
Y
Ohue
Masayuki
M
Yasuda
Takushi
T
Imamura
Hiroshi
H
Tatsuta
Masayuki
M
Yano
Masahiko
M
Furukawa
Hiroshi
H
Monden
Morito
M
D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods; D013162:Splenic Vein / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology