Portal vein thrombosis after elective splenectomy. An underappreciated, potentially lethal syndrome
D. W. Rattner, L. Ellman and A. L. Warshaw
Department of Surgery, Massachusetts General Hospital, Boston 02114.
We describe seven cases of thrombosis of the portal and splenic vein after
elective splenectomy. The diagnosis was initially unrecognized in all
patients and was confused with biliary sepsis (three cases), postoperative
pancreatitis (three cases), or pulmonary emboli (one case). Two patients in
whom the diagnosis of portal vein thrombosis was not made within 3 days of
disease onset died. In the five survivors, the diagnosis was based on
clinical suspicion, confirmed with color flow Doppler ultrasonography or
computed tomography with intravenous contrast material, and treated with
thrombolytic agents, anticoagulants, and antibiotics. In two patients,
splenic vein thrombus was visualized on initial postoperative imaging
studies and the thrombus subsequently extended into the portal vein. Portal
vein thrombosis should be considered in patients with fever and abdominal
complaints after splenectomy. Urgent treatment with thrombolysis and
anticoagulants may preserve bowel integrity and be lifesaving.
