title: Intra-abdominal venous thrombosis after colectomy in pediatric patients with chronic ulcerative colitis: incidence, treatment, and outcomes.
abstract: OBJECTIVE
  Children with chronic ulcerative colitis (CUC) are at increased risk for venous thromboembolism, especially after colectomy procedures. We aim to review our patients with CUC who underwent a colectomy and suffered intra-abdominal thrombosis; moreover we wanted to define thrombotic incidence and outcomes
  
  
  METHODS
  In this is IRB approved retrospective study, we reviewed our patients who underwent colectomy for CUC from January 1999 to December 2011 for development of intra-abdominal thrombosis.
  
  
  RESULTS
  Of 366 patients with CUC who underwent colectomy, 15 (4%) were diagnosed with a venous thromboembolism. All patients presented with acute abdominal pain. The locations of thrombus formation varied: 13 (87%) developed thrombi in the portal vein, 4 (27%) in the splenic vein, 2 (13%) in the superior mesenteric vein, 1 (7%) in the hepatic vein, and 1 (7%) in the hepatic artery. The mean number of post-operative days at diagnosis of thrombus was 38.7 days (range 3-180 days). Fourteen patients (93%) underwent anticoagulation for treatment. The mean number of days of anticoagulant therapy until documented resolution of thrombus on imaging was 96.3 days (range 14-364 days). All thrombi resolved with therapy. There was no mortality during follow-up.
  
  
  CONCLUSIONS
  Four percent of our pediatric patients with chronic ulcerative colitis who underwent colectomy developed symptomatic intra-abdominal venous thromboembolism. 3 to 6 months of anticoagulant therapy is adequate treatment in almost all patients. Practitioners should have a high index of suspicion for intra-abdominal venous thrombus when these patients complain of abdominal pain postoperatively. Based on our experience, prophylactic anticoagulation should be strongly considered peri-operatively in this population.
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Antiel
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Yassar
authors.initials: Y
authors.lastname: Hashim
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Vilmarie
authors.initials: V
authors.lastname: Rodriguez
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tarig
authors.initials: T
authors.lastname: Elraiyah
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: Zarroug.abdalla@mayo.edu.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002908:Chronic Disease; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Colectomy; Thrombus; Ulcerative colitis; Venous thromboembolism