Dw. Rattner et al., PORTAL-VEIN THROMBOSIS AFTER ELECTIVE SPLENECTOMY - AN UNDERAPPRECIATED, POTENTIALLY LETHAL SYNDROME, Archives of surgery, 128(5), 1993, pp. 565-570
We describe seven cases of thrombosis of the portal and splenic vein a
fter elective splenectomy. The diagnosis was initially unrecognized in
all patients and was confused with biliary sepsis (three cases), post
operative pancreatitis (three cases), or pulmonary emboli (one case).
Two patients in whom the diagnosis of portal vein thrombosis was not m
ade within 3 days of disease onset died. In the five survivors, the di
agnosis was based on clinical suspicion, confirmed with color flow Dop
pler ultrasonography or computed tomography with intravenous contrast
material, and treated with thrombolytic agents, anticoagulants, and an
tibiotics. In two patients, splenic vein thrombus was visualized on in
itial postoperative imaging studies and the thrombus subsequently exte
nded into the portal vein. Portal vein thrombosis should be considered
in patients with fever and abdominal complaints after splenectomy. Ur
gent treatment with thrombolysis and anticoagulants may preserve bowel
integrity and be lifesaving.