Postsplenectomy Portal Vein Thrombosis: Personal Experience and Review of the Literature

General Surgery Postsplenectomy Portal Vein Thrombosis: Personal Experience and Review of the Literature Vecchio Rosario, MD, Intagliata Eva, MD, Leanza Vito, MD, Marchese Salvatore, MD, Cacciola Emma, MD Department of General Surgery, University of Catania, Catania, Italy (Drs. Rosario, Eva, Salvatore). Department of Gynecology, University of Catania, Catania, Italy (Dr. Vito). Department of Biomedical Science, Section of Haematology, University of Catania, Catania, Italy (Dr. Emma). Objective: Portal vein thrombosis can be a life-threatening complication of splenectomy if not diagnosed in time and treated properly. The actual incidence of postsplenectomy portal system thrombosis is not clearly determined, ranging between 0.7% and 80%. In this series, we report the incidence and therapeutic strategies. Methods: Between 1993 and 2008, 162 patients underwent laparoscopic splenectomy for hematologic disease. The main indication was idiopathic thrombocytopenic purpura (106 patients). Portal vein thrombosis was evaluated clinically and diagnosed by using abdominal computed tomography. Results: Clinically evident portal vein thrombosis has been diagnosed in 4 patients, 3 of them treated by laparoscopic splenectomy. Treatment of these patients was successfully obtained by conservative therapy with high-dose heparin for at least 3 weeks. Conclusions: Laparoscopy might increase the risk of the development of portal vein thrombosis, because it reduces blood flow in the portal system veins due to pneumoperitoneum. However, it seems to be associated with fewer intraoperative and postoperative modifications of coagulation and fibrinolytic parameters than open surgery is, which might prevent, on the other hand, portal vein thrombosis. Hematologic diseases and greater spleen weight are recognized potential risk factors for portal vein thrombosis, whose incidence proportionally increases with the enhancement of the dimensions of the spleen. Anticoagulation therapy treatment for 3 weeks after splenectomy was successful in all patients. According to authors’ experience, postoperative surveillance for portal vein thrombosis is mandatory in splenectomized patients at high risk. Perioperative thrombotic prophylaxis should be considered in select patients.