High rate of portal thrombosis after splenectomy in patients with esophageal varices and idiopathic portal hypertension
A. Eguchi, M. Hashizume, S. Kitano, K. Tanoue, H. Wada and K. Sugimachi
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Data on 126 consecutive patients who were admitted to our clinics from
January 1979 to May 1989 were scrutinized to assess changes in portal
hemodynamics following splenectomy. Two groups were classified: (1) a group
of 106 patients with cirrhosis of the liver and (2) a group of 20 patients
with idiopathic portal hypertension (IPH). Portal thrombosis was present in
five (25.0%) of the 20 patients with IPH and in two (1.8%) of the 106
patients with cirrhosis of the liver. As seen on celiac arteriography, the
mean (+/- SD) diameter of the trunk of the splenic artery and vein was 8.99
+/- 1.55 and 16.2 +/- 3.6 mm, respectively, in patients with IPH, while it
was 7.94 +/- 1.28 and 14.2 +/- 3.1 mm, respectively, in patients with
cirrhosis of the liver. Changes in portal venous pressure were 78.4 +/-
59.4 mm H2O in patients with IPH and 43.5 +/- 38.7 mm H2O in patients with
cirrhosis of the liver. There were no significant differences in the
maximum level of thrombocytes in patients with IPH or in those patients
with cirrhosis of the liver. These events suggest that portal thrombosis
can occur with a significantly higher incidence in patients with IPH than
in those patients with cirrhosis of the liver after splenectomy, and a
decrease in blood flow in the portal vein may be closely linked to the
formation of portal thrombosis after splenectomy in patients with IPH.
Preoperative examination of portal hemodynamics must be thorough.
