Hypothesis: Splenectomy is recognized as a cause of portal, mesenteric,
and splenic vein thrombosis. The exact incidence of the complication and
its predisposing factors are not known.
Design: Prospective observational cohort study. The median follow-up
time of the patients was 22.6 months.
Setting: University surgical clinic in a teaching hospital
Patients: A total of 147 consecutive patients who underwent splenectomy
in a 4-year period were enrolled in the study.
Interventions: Preoperative and postoperative evaluation included
ultrasonography with color Doppler flow imaging of the portal system,
results of blood coagulation tests, fibrinogen levels, D-dimer levels,
and complete blood counts. Operative sheets were recorded and reviewed.
When portal system thrombosis (PST) was diagnosed, a complete control
for acquired and congenital thrombophilia disorders was obtained.
Main Outcome Measures: Primary end points of the study were the
assessment of the incidence of postsplenectomy PST and the
identification of risk factors for its occurrence.
Results: Portal system thrombosis occurred in 7 (4.79%) of 146 patients
who underwent splenectomy. The age, sex, type or length of the
operation, and use of preoperative and postoperative thromboprophylaxis
with low molecular weight heparin did not prove to be significant
factors in the occurrence of PST. Platelet count of more than 650 X
10(3)/mu L and greater spleen weight (> 650 g) was associated with the
development of PST (P=.01, P=.03). Normal D-dimer levels on diagnosis of
the complication showed a negative predictive value of 98%. Two of the
affected patients were diagnosed with thrombophilia disorders. In a
median follow-up period of 22.6 months, no other case of PST was
recorded.
Conclusions: Postsplenectomy PST occurs in approximately 5% of
patients. Possible risk factors are thrombocytosis, splenomegaly, and
congenital thrombophilia disorders
