title: Portal vein thrombosis after laparoscopic splenectomy during childhood.
abstract: Portal vein thrombosis (PVT) is a rare but potentially life-threatening complication of laparoscopic splenectomy (LS) and can lead to bowel ischemia or portal hypertension. In childhood, this complication is reported in 5-10 % of the cases whereas it can be up to 50 % in adult population. Our aim was to evaluate PVT incidence after LS and associated risks factors. A retrospective chart review identified 37 children who underwent elective LS from 2005 to 2013. The main indications were spherocytosis or sickle cell disease. Median age and weight were respectively 7.4 years and 25.1 kg. Thromboembolic prophylaxis was not routinely given. Duration of surgery was 129 min and hospital length of stay 4 days. Doppler ultrasound scan (USS) was performed post-operatively in 26 cases. Post-operative course was uneventful in all but one patient. She was a 17 year-old girl previously operated for an ovarian tumor with hyperandrogenism. Histopathology revealed a splenic lymphoma. At day 4, a systematic USS showed a PVT extending in the portal branches. Therapeutic low molecular weight heparin was used and then transitioned to fluindione for 3 months. Follow-up USS performed at 1 and 4 months demonstrated complete resolution of the PVT. PVT after pediatric LS is a rare event in our series. Clinician should be cautious in oncologic cases and if very large spleen or if thrombocythemia >650.10(9)/L is present. If detected early, PVT can be treated efficiently. We therefore recommend a systematic USS during the first postoperative week.
authors: Pediatric Surgery Department, Femme Mère Enfant Hospital - Hospices Civils de Lyon and Claude Bernard University Lyon 1, 59 Boulevard PINEL, 69500, Bron, France, thomas.gelas@chu-lyon.fr.
authors: Thomas
authors: T
authors: Gelas
authors: Aurélien
authors: A
authors: Scalabre
authors: Frédéric
authors: F
authors: Hameury
authors: Rémi
authors: R
authors: Dubois
authors: Céline
authors: C
authors: Grosos
authors: Pierre D
authors: PD
authors: Mouriquand
authors: Pierre-Yves
authors: PY
authors: Mure
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein; D011183:Postoperative Complications; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D014463:Ultrasonography