Portal vein thrombosis postlaparoscopic splenectomy presenting with infarction of gut: review of risk factors, investigations, postoperative surveillance, and management.
Portal vein thrombosis after laparoscopic splenectomy is a known complication even though it is underappreciated. Presenting symptoms are usually mild and nonspecific. Progression to intestinal infarction and portal hypertension are potentially life threatening complications. The short hospital stay associated with laparoscopic approach could delay early diagnosis, unless routine imaging studies is planned after discharge. We present a patient who after laparoscopic splenectomy for idiopathic thrombocytopenic purpura developed portal vein thrombosis leading to infarction of small intestine 9 days after the surgery. She made uneventful recovery after resection and anticoagulation. Literature is reviewed to assess the risk factors and discuss the present status regarding investigations, surveillance in postoperative period, management of established case, and role of prophylactic anticoagulation.
Machado
Norman Oneil
NO
Department of Surgery daggerDepartment of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman. norman@omantel.net.om
Chopra
Pradeep J
PJ
Sankhla
Dilip
D
D000328:Adult; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007583:Jejunum / Q000098:blood supply*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy