Post-Splenectomy Portal Venous Thrombosis in Cirrhotic Patients: An Observational Clinical Trial
Journal of Surgery
Volume 5, Issue 6, December 2017, Pages: 105-110
Received: Sep. 22, 2017; Accepted: Oct. 4, 2017; Published: Nov. 12, 2017
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Hamdy Sedky Abd Allah, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohamad Hamdy Abo-Ryia, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Sherif Abd-Al Fattah Saber, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Background: Post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients’ lives. Different variables were identified as risk factors for PS-PVT in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients. Patients and methods: Sixty cirrhotic patients of Child class A submitted to open splenectomy were observed, both clinically and by Duplex ultrasound (US) examination, for the development of PS-PVT. Results: Overall, 17 patients (28.3%) developed PS-PVT at a median interval of 4.5 days (21 hours-7 days) post-splenectomy. Univariate analysis showed that lower preoperative platelet count (P<0.0460) and white blood cell (WBC) count (P<0.0001) and wider splenic vein diameter (SVD) (P<0.0001) correlated with PS-PVT. Multivariate analysis identified lower preoperative WBC count [odds ratio (OR): 0.651, 95% confidence interval (CI): 0.245-0.893, P<0.005] and wider SVD (OR: 2.383, 95% CI: 1.558-3.646., P<0.001) as independent risk factors of PS-PVT. While 16 out of the 17 patients (94%) who had these 2 risk factors developed PS-PVT, only 1 out of the 43 patients (2.3%) who didn’t have the same risk factors developed thrombosis. All 17 patients had complete resolution of their thrombosis on anticoagulation therapy within 3-6 months without complications or mortality. Conclusion: PVT is a common complication of splenectomy in cirrhotic patients. Patients with low WBC count and wide SVD are highly susceptible to develop this complication mandating close observation from the 1st PO day and immediate anticoagulation after diagnosis.
Splenectomy, Portal Vein Thrombosis, Cirrhosis, Risk Factors
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Hamdy Sedky Abd Allah, Mohamad Hamdy Abo-Ryia, Sherif Abd-Al Fattah Saber, Post-Splenectomy Portal Venous Thrombosis in Cirrhotic Patients: An Observational Clinical Trial, Journal of Surgery. Vol. 5, No. 6, 2017, pp. 105-110. doi: 10.11648/j.js.20170506.14
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