Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment.
BACKGROUND
Portal or splenic vein thrombosis (PSVT) is a common disorder after laparoscopic splenectomy (LS). Splenomegaly is a well-known risk factor for PSVT. However, no treatment strategy for PSVT has been established.


METHODS
Thirty-three consecutive patients who had undergone LS and postoperative imaging surveillance were examined. PSVT was classified according to the site of thrombosis. We evaluated patient background, operative factors, and clinical symptoms.


RESULTS
Spleen weight of patients with PSVT (n = 17, median 218 g) was greater than that of patients without PSVT (n = 16, median 101 g). Seven patients developed thrombosis involving the entire splenic vein (total splenic vein thrombosis), and 4 of them had clinical symptoms (fever >38 degrees C and/or abdominal pain). The incidence of clinical symptoms was significantly more frequent in patients with than without total SVT. Operation time, blood loss, and spleen weight were also significantly greater in patients with total SVT. Multiple logistic regression analysis demonstrated spleen weight was the strongest predictor of PSVT and total SVT.


CONCLUSIONS
Patients with total SVT have greater risk factors for PSVT and frequently have clinical symptoms. They are candidates for anticoagulation therapy.
Ikeda
Masataka
M
Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan. mikeda@surg2.med.osaka-u.ac.jp
Sekimoto
Mitsugu
M
Takiguchi
Shuji
S
Yasui
Masayoshi
M
Danno
Katsuki
K
Fujie
Yujiro
Y
Kitani
Kotaro
K
Seki
Yosuke
Y
Hata
Taishi
T
Shingai
Tatsushi
T
Takemasa
Ichiro
I
Ikenaga
Masakazu
M
Yamamoto
Hirofumi
H
Ohue
Masayuki
M
Monden
Morito
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D013156:Splenectomy / Q000009:adverse effects*; D013158:Splenic Diseases / Q000145:classification / Q000601:surgery; D013162:Splenic Vein / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology*