Thrombosis of the splenoportal axis after splenectomy.
OBJECTIVE
Thrombosis of the portal system is a potentially life-threatening complication after splenectomy. The reported incidence is low (approximately or = 1%), however may be underestimated due to difficult in making the diagnosis. The factors associated with its development and the clinical outcome are poorly characterized. The aim of this study was to assess the incidence, risk factors, treatment, and outcome in series of consecutive cases.


METHODS
All patients who had undergone a splenectomy (both open and laparoscopic) between January 1997 and December 2004 at the Department of Surgery of University of Milan Bicocca were retrospectively reviewed. Twelve cases of thrombosis (7.6%) among 158 splenectomies were identified. No significant differences were noted in age, gender, and surgical approach between patients who developed thrombosis and those who did not. Indication for splenectomy in patients with thrombosis were myeloproliferative disorders (n=5), hemolytic disease (n=4), and lymphoproliferative disorder (n=3). All patients had splenomegaly (mean 1.380 kg, range 0.400-3.120 kg).


RESULTS
Among patients with myeloproliferative disorders, five (33%) developed the complication, compared with 4 of 35 (11.5%) with hemolytic disease. Patients with both splenic weight >2.500 kg and myeloproliferative disorders had 80% incidence of portal thrombosis. Preoperative prophylactic anticoagulant therapy with low molecular weight heparin was administered in each case. All these patients had fever, abdominal pain, or leukocytosis. All diagnoses were made by contrast-enhanced computed tomography (CT) scan and ecocolordoppler ultrasonography, and anticoagulation therapy was initiated immediately. Treatment within 15 days after splenectomy was successful in all patients, while delayed treatment was ineffective.


CONCLUSIONS
Portal thrombosis should be suspected in patients with fever or abdominal pain after splenectomy. Patients with myeloproliferative disorders and hemolytic diseases are at higher risk, as well as patients with marked splenomegaly. A high index of suspicion, early diagnosis, and prompt anticoagulation therapy are the keys to a successful outcome.
Romano
Fabrizio
F
Department of Surgery (Chirurgia I), San Gerardo Hospital, II University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy. fabriziorom@hotmail.com
Caprotti
Roberto
R
Conti
Matteo
M
Piacentini
Maria Gaia
MG
Uggeri
Fabio
F
Motta
Vittorio
V
Pogliani
Enrico Maria
EM
Uggeri
Franco
F
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011292:Premedication; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
D006495:Heparin, Low-Molecular-Weight