Portal vein thrombosis after laparoscopic splenectomy in benign hematologic diseases.
BACKGROUND
Portal vein thrombosis is an unfrequent, but potentially deadly, complication of the laparoscopic splenectomy procedure. The laparoscopic approach has shortened the duration of hospital stay; portal vein thrombosis may appear after the patient has left the hospital, determining a later diagnosis. Because of the mild, nonspecific symptoms, the diagnosis can even be missed and only achieved when chronic complications take place.


OBJECTIVE
In this study, we aimed to determine the appearance of portal vein thrombosis in a consecutive series of patients who underwent laparoscopic splenectomy by performing a contrast-enhanced computed tomography (CT) scan postoperatively.


METHODS
A transversal study was established, performing in 2005 a contrast-enhanced CT scan on 20 patients who underwent laparoscopic splenectomy between 1999 and 2005 at Ramón y Cajal University Hospital (Madrid, Spain). The presence of thrombosis in the splenoportomesenteric axis was investigated.


RESULTS
Two (2) cases (10%) of portal vein thrombosis were detected: 1 symptomatic case, 7 days after surgery, was treated with anticoagulation, resulting in the disappearance of the thrombus in a new CT scan 6 months later; the second case was asymptomatic and was discovered during the performance of this study.


CONCLUSIONS
The contrast-enhanced CT scan shows the best accuracy for the diagnosis of portal vein thrombosis, and it must be performed when any clinical manifestation appear; also, it must still be determined if a contrast-enhanced CT scan should be systematically performed in high-risk thromboembolic patients. An ultrasound Doppler may present many diagnostic errors. It is probably advisable to prolong the antithromboembolic prophylaxis.
Ruiz-Tovar
Jaime
J
Department of Surgery, University Hospital Ramón y Cajal, Madrid, Spain. jruiztovar@gmail.com
Pérez de Oteyza
Joaquín
J
Blázquez Sánchez
Javier
J
Aguilera Velardo
Asunción
A
Rojo Blanco
Roberto
R
Collado Guirao
Maria Vicenta
MV
García Villanueva
Augusto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*