Portal Vein Thrombosis After Laparoscopic Splenectomy:

Rosario Vecchio, MD, Emma Cacciola, MD, Eva Intagliata, MD, Salvatore Marchese, MD, Rossella Cacciola, MD, Guido Zanghì, MD, Francesco Basile, MD. Dept of Surg University of Catania Ialy

Objective: Portal vein thrombosis (PVT) 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, the Authors report their incidence in laparoscopic splenectomy and therapeutic strategies.
Methods: Between 1998 and 2009, 102 patients were submitted to laparoscopic splenectomy for hematologic disease. PVT was evaluated clinically and diagnosed by means of abdominal computed tomography.
Results: Clinically evident PVT has been diagnosed in 3 patients treated by laparoscopic splenectomy affected by lymphoma (2 cases) and β-thalassemia (1 case). Treatment of these patients was successfully obtained by conservative therapy with high dose of heparin for at least 3 weeks. In one case an ileal resection for intestinal ischemia was needed.
Conclusions: Laparoscopic splenectomy, expecially in patients with large spleen and/or affected by mielo-lymphoproliferative disorders, may be complicated by PVT. Early recognition and proper immediate treatment is mandatory in these cases. Anticoagulation therapy treatment for 3 weeks after splenectomy was successful in all patients treated immediately. According to our experience, postoperative surveillance for portal vein thrombosis is mandatory in splenectomised patients at high risk. Perioperative thrombotic prophylaxis should be considered in selected patients.