Portal vein thrombi after ileal pouch-anal anastomosis: its incidence and association with pouchitis.
OBJECTIVE
Portal vein thrombi (PVT) have recently been linked to ileal pouch-anal anastomosis (IPAA). We assessed the rate of PVT in patients who underwent IPAA and attempted to identify the associated features.


METHODS
We reviewed all patients who underwent IPAA at our hospital between 1997 and 2002, noting demographic, operative, and clinical data. Computed tomography (CT) scans were independently re-reviewed by two radiologists blinded to patient data. Scans were designated as positive, negative, or indeterminate for PVT.


RESULTS
A total of 112 patients underwent IPAA for ulcerative colitis, 28 (25%) of whom had a CT scan done within 8 weeks postoperatively. The indications for CT included prolonged ileus (32.1%), abdominal pain (28.6%), and fever (17.9%). On examining the CT scans, 39% were positive, 14% were indeterminate, and 46% were negative for PVT. There was no association between PVT and pelvic sepsis. Within a mean follow-up of 36.2 months, 15.4% patients without PVT had suffered pouchitis compared with 25% of those with indeterminate scans and 45.5% of those with PVT.


CONCLUSIONS
Portal vein thrombi are a common finding in the subset of patients who require a CT scan after IPAA. Patients who suffer PVT have a higher incidence of postoperative pouchitis. Thus a prospective evaluation of the risk of PVT and its association with pouchitis is warranted.
Ball
Chad G
CG
Department of Surgery, Foothills Medical Centre, University of Calgary, 1403-29 Street N.W., Calgary, AB, T2N 2T9, Canada.
MacLean
Anthony R
AR
Buie
W Donald
WD
Smith
Dean F
DF
Raber
Earl L
EL
D000328:Adult; D000416:Alberta / Q000453:epidemiology; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011169:Portal Vein; D019449:Pouchitis / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology