Portal vein thrombosis after laparoscopic splenectomy during childhood
Thomas Gelas1, Aurélien Scalabre, Frédéric Hameury
1Pediatric Surgery Department, Femme Mère Enfant Hospital - Hospices Civils de Lyon and Claude Bernard University Lyon 1, 59 Boulevard PINEL, 69500, Bron, France, thomas.gelas@chu-lyon.fr.
Insights
Portal vein thrombosis (PVT) is a rare complication after laparoscopic splenectomy (LS) in children. Early detection with ultrasound and prompt treatment can lead to complete resolution.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Hematology
Background:
- Portal vein thrombosis (PVT) is a serious complication of laparoscopic splenectomy (LS), with reported incidence rates of 5-10% in children and up to 50% in adults.
- PVT can lead to severe outcomes such as bowel ischemia and portal hypertension.
Purpose of the Study:
- To evaluate the incidence of PVT after LS in a pediatric population.
- To identify risk factors associated with PVT development post-LS.
Main Methods:
- Retrospective chart review of 37 children undergoing elective LS between 2005 and 2013.
- Indications for LS included spherocytosis and sickle cell disease.
- Post-operative Doppler ultrasound scans (USS) were performed in 26 cases.
Main Results:
- PVT occurred in only one patient, a 17-year-old girl with splenic lymphoma.
- This patient was successfully treated with anticoagulation (low molecular weight heparin and fluindione) for 3 months, with complete PVT resolution confirmed by USS.
- Risk factors for PVT in oncologic cases, very large spleen, or thrombocythemia >650.10(9)/L were noted.
Conclusions:
- PVT is a rare complication following pediatric LS in this series.
- Early detection via systematic post-operative USS within the first week is recommended.
- Prompt treatment of PVT leads to efficient resolution.
Abstract:
Portal vein thrombosis (PVT) is a rare but potentially life-threatening complication of laparoscopic splenectomy (LS) and can lead to bowel ischemia or portal hypertension. In childhood, this complication is reported in 5-10 % of the cases whereas it can be up to 50 % in adult population. Our aim was to evaluate PVT incidence after LS and associated risks factors. A retrospective chart review identified 37 children who underwent elective LS from 2005 to 2013. The main indications were spherocytosis or sickle cell disease. Median age and weight were respectively 7.4 years and 25.1 kg. Thromboembolic prophylaxis was not routinely given. Duration of surgery was 129 min and hospital length of stay 4 days. Doppler ultrasound scan (USS) was performed post-operatively in 26 cases. Post-operative course was uneventful in all but one patient. She was a 17 year-old girl previously operated for an ovarian tumor with hyperandrogenism. Histopathology revealed a splenic lymphoma. At day 4, a systematic USS showed a PVT extending in the portal branches. Therapeutic low molecular weight heparin was used and then transitioned to fluindione for 3 months. Follow-up USS performed at 1 and 4 months demonstrated complete resolution of the PVT. PVT after pediatric LS is a rare event in our series. Clinician should be cautious in oncologic cases and if very large spleen or if thrombocythemia >650.10(9)/L is present. If detected early, PVT can be treated efficiently. We therefore recommend a systematic USS during the first postoperative week.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Esophageal Varices-I: Introduction