Hamdy S Abd Alla, PhD. Faculty of medicine, Tanta University, EGYPT
Background: Post-splenectomy portal venous thrombosis carries multiple threats to patients’ lives. Different variables were identified as risk factors for this complication in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of post-splenectomy portal venous thrombosis in cirrhotic patients.
Patients and methods: Sixty cirrhotic patients of Child class A submitted to open splenectomy for various indications at my institution during the period from March 2008 to March 2016. were observed, both clinically and by Duplex ultrasound examination for the development of post-splenectomy portal venous thrombosis
Results: Overall, 17 patients (28.3%) developed post-splenectomy portal venous thrombosis at a median interval of 4.5 days (21 hours-7 days) post-splenectomy. Univariate analysis showed that lower preoperative platelet count (P<0.0460), lower preoperative white blood cell count (P<0.0001) and wider splenic vein diameter (P<0.0001) correlated with post-splenectomy portal venous thrombosis. Multivariate analysis identified lower preoperative white blood cell count [odds ratio (OR): 0.651, 95% confidence interval (CI): 0.245-0.893, P<0.005] and wider splenic vein diameter (OR: 2.383, 95% CI: 1.558-3.646., P<0.001) as independent risk factors of post-splenectomy portal venous thrombosis. While 16 out of the 17 patients (94%) who had these 2 risk factors developed portal venous thrombosis, only 1 out of the 43 patients (2.3%) who didn’t have the same risk factors developed portal venous thrombosis. All 17 patients had complete resolution of their thrombosis on anticoagulation therapy within 3-6 months without complications or mortality.
Conclusion: Portal venous thrombosis is a common complication of splenectomy in cirrhotic patients. Patients with low white blood cell count count and wide splenic vein diameter are highly susceptible to develop this complication mandating close observation from the 1st postoperative day and immediate anticoagulation after diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88051
Program Number: P520
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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