Postoperative portal vein thrombosis in patients with hepatosplenic mansonic schistosomiasis: relationship with intraoperative portal pressure and flow. A prospective study.
OBJECTIVE
Portal vein thrombosis is a frequent postoperative complication after esophagogastric devascularization with splenectomy. The aim of this study was to analyze biochemical, hematological, coagulation blood tests and intraoperative portal vein hemodynamics after surgical treatment of hepatosplenic Mansonic schistosomal portal hypertension.


METHODS
Forty patients with hepatosplenic schistosomiasis with indication for surgical treatment were prospectively studied. All patients underwent routine pre- and postoperative biochemical, hematologic, coagulation blood tests and intraoperative portal hemodynamic evaluation (portal pressure and portal flow) before and after esophagogastric devascularization and splenectomy using a 4-F thermodilution catheter introduced inside the portal vein.


RESULTS
Portal vein thrombosis, diagnosed by routine postoperative Doppler ultrasonography was found in 22 patients (55%). It was partial in nineteen and total in three. In patients with postoperative portal thrombosis, we observed a reduction in portal flow of 971 +/- 592 mL/min (42 +/- 16%) at the end of the surgery, while this reduction was of 720 +/- 644mL/ min (33 +/- 30%) in those with postoperative pervious portal vein (p = 0.245). The decrease in portal pressure was the same in both groups: 7.2 +/- 3.0 mmHg (23 +/- 10%) and 7.6 +/- 3.8 mmHg (27 +/- 14%) with and without thrombosis respectively (p=0.759). There was also no significant difference between patients with and without portal vein thrombosis regarding pre- and postoperative hemoglobin level or platelet levels, coagulation tests, portal vein diameter and spleen's weight.


CONCLUSIONS
Portal vein thrombosis was observed in 55% of the patients but this complication did not show any correlation with the decrease in portal flow or pressure or with biochemical, hematologic, coagulation blood tests, portal vein diameter or spleen's weight.
de Cleva
Roberto
R
Gastroenterology Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. roberto.cleva@hcnet.usp.br
Herman
Paulo
P
Saad
William Abrão
WA
Pugliese
Vincenzo
V
Zilberstein
Bruno
B
Rodrigues
Joaquim José Gama
JJ
Laudanna
Antonio Atílio
AA
D016145:Endoscopy, Digestive System; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007432:Intraoperative Period; D008109:Liver Diseases, Parasitic / Q000150:complications* / Q000601:surgery; D011168:Portal System / Q000503:physiopathology; D011169:Portal Vein; D011446:Prospective Studies; D012555:Schistosomiasis mansoni / Q000150:complications* / Q000601:surgery; D013158:Splenic Diseases / Q000469:parasitology* / Q000601:surgery; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*