A case of portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy in a child.
We report the case of an 8-year-old boy with a red cell membrane disorder who developed, soon after undergoing laparoscopic cholecystectomy and splenectomy, complete thrombosis of the right branch and a partial occlusion of the left branch of the portal vein. The child was affected by a right hemiparesis because of a hypoxic-ischemic disorder that occurred in the first hours of life and was heterozygous for the methylenetetrahydrofolate reductase gene mutation 677C-T. Intravenous heparin and aspirin were initiated on postoperative day 7. Heparin treatment was switched to the subcutaneous route after the first 24 hours. The symptoms subsided 3 days after the beginning of treatment, whereas complete resolution of portal vein thrombosis was observed 2 months later. A review of the literature is reported, and the possible pathogenetic mechanisms underlying portal vein thrombosis are discussed.
Rossi
Enrica
E
Operative Unit of Pediatric Surgery, Arcispedale S. Anna, 44100 Ferrara, Italy. dr_ross28@hotmail.com
Michelini
Maria Elena
ME
Pignatti
Caterina Borgna
CB
Zanotti
Fausto
F
Franchella
Andrea
A
D000745:Anemia, Hemolytic, Congenital / Q000601:surgery*; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D009154:Mutation; D011169:Portal Vein; D013156:Splenectomy / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy
D000925:Anticoagulants; D006493:Heparin; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D001241:Aspirin