PORTAL-VEIN THROMBOSIS FOLLOWING SPLENECTOMY FOR HEMATOLOGIC DISEASE - PROSPECTIVE-STUDY WITH DOPPLER COLOR-FLOW IMAGING

We report the results of a prospective series of 60 consecutive splene ctomies for hematologic disorders performed between February 1995 and May 1996. The portal venous flow of all the patients (34 men and 26 wo men with a mean age of 54.1 years) was systematically studied before a nd after intervention with Doppler color imaging (on the day before th e intervention and on the 7th and 30th postoperative days). The object ive of this study were to determine the real frequency of asymptomatic portal or splenic venous thrombosis (PSVT) after hematologic splenect omy. The intervention began with exteriorization of the spleen and the tail of the pancreas; ligation of the splenic vein was performed clos e to its junction with the inferior mesenteric vein. Twenty-three comp lications (38.3%) were noted with three deaths (5%). One symptomatic P SVT (1.6%) and three asymptomatic PSVTs (6.7%) were diagnosed and trea ted with no deaths. Three risk factors of PSVT, recognized by all the authors, were present in these four cases: large splenomegaly, thrombo cytosis, or myeloproliferative disorder. The systematic ultrasonograph ic (US) examinations increased the frequency of diagnosis of PSVT seve nfold during the perioperative period. Patients with marked splenomega ly associated with lymphoma, chronic lymphocytic leukemia, or myeloid metaplasia probably require systematic US monitoring during follow-up, but this must be determined by further study.