title: Portal venous system thrombosis after pancreatic resection.
abstract: BACKGROUND
  Portal venous system thrombosis (PVST) is a rare, potentially fatal complication after pancreatic resection. The aim of this study was to assess the incidence, presenting symptoms, management, and treatment of PVST in a large cohort of patients.
  
  
  METHODS
  Prospectively collected data on patients undergoing pancreatic resection between 1997 and 2009 were reviewed retrospectively. Preoperative and postoperative imaging were analyzed for the presence or absence of venous thrombi. All patients received standard thromboprophylaxis with low-molecular-weight heparin (LMWH).
  
  
  RESULTS
  Of 516 pancreatic resections performed, 18 (3.5 %) were complicated by PVST. The most common clinical presentations were abdominal pain (n = 9) and ascites (n = 5) but never any alarm symptoms. Other symptoms were vague and nonspecific (e.g., weight loss, fatigue, fever). Total pancreatectomy was a risk factor compared to hemipancreatectomy (p < 0.01), whereas the underlying disease per se did not make any difference. The median interval between surgery and diagnosis of PVST was 105 days (range 1-1,440 days). PVST was at least a contributing factor in the postoperative deaths of two patients. LMWH therapy did not significantly affect survival.
  
  
  CONCLUSIONS
  PVST remains a relatively infrequent complication after pancreatic resection. Because accurate diagnosis and timely intervention may reduce morbidity and mortality, the possibility of PVST should be considered in patients presenting with vague symptoms. Whether anticoagulant treatment is needed is still not clear; there were no obvious differences in outcome between treated and untreated patients.
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet at Department of Surgical Gastroenterology, Karolinska University Hospital, 141 86 Stockholm, Sweden. david.ansari@akademiska.se
authors.forename: David
authors.initials: D
authors.lastname: Ansari
authors.forename: Christoph
authors.initials: C
authors.lastname: Ansorge
authors.forename: Ake
authors.initials: A
authors.lastname: Andrén-Sandberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansari
authors.forename: Ralf
authors.initials: R
authors.lastname: Segersvärd
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D011168:Portal System; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D055815:Young Adult