Portal Vein Thrombosis a Common Complication Following Splenectomy in Adults Patients with CLL or Myeloproliferative Disease.

Elective laparoscopic splenectomy (LS) is performed with increasing frequency in relation to open splenectomy (OS). The advantage with LS is reduced morbidity. Moreover, this method is feasible also in patients with splenomegaly, a patient group with more postoperative complications as bleeding, infections and portal vein thrombosis. Portal vein thrombosis (PVT) is a rare but serious complication of splenectomy. We retrospectively reviewed the medical records of 69 consecutive patients splenectomized for haematological diseases during a five-years period (Jan 1999 to Dec 2003) at the Dep. of Surgery Huddinge University Hospital, with the aim of comparing the results and complications after LS and OS, with focus on thromboembolic events. The follow-up for all patients was performed Jan 31. 2004. Thirty-nine patients underwent LS and 30 OS. There were three conversions (7.7%) from laparoscopic to open surgery due to bleeding and splenomegaly. Accessory spleens were found in 16 of 69 (23%) patients, 6 of 39 (15%) in LS and 10 of 30 (33%) in OS. Thromboembolic complications were seen in seven patients; a) deep vein thromboses in the lower leg in two patients with ITP, both with LS and neither had received thromboprophylaxis, b) PVT in five patients, one after LS and four after OS; three with CLL, (two with a concomitant haemolytic anaemia) and two with a myeloproliferative disease. The five patients with PVT had all splenomegaly and had received thromboprophylaxis with low-molecular-weight heparin. PVT was diagnosed from day 6 to day 111 after splenectomy. Three of the five patients had thrombocytosis, 478, 740 and 1459x 10(9) at the time of PVT-diagnosis. In all the splenectomized patients, two patients had overwhelming post splenectomy sepsis (OPSI). One patient with Evans syndrom died of E. coli sepsis four months after splenectomy and one patient with myelofibrosis had severe pneumococksepsis 44 months after splenectomy. Both had recieved preoperative pneumocock vaccination. Further seven patients died during the follow-up period, five due to infections and bleedings, in all related to progressive malignant lymphoma. One patient died of sudden cardiac arrest 15 months postoperative, and one patient performed suicide. Conclusions: Portal vein thrombosis after splenectomy was seen in 13.5 % of patients with haematological malignancies despite thromboprophylaxis. Patients with splenomegaly and myeloproliferative disease or CLL with haemolytic anaemia have high risk of PVT. We recommend careful observation of postoperative thrombocytosis and extended thromboprophylaxis. Ultrasonography or CT should be considered in all patients with abdominal symtoms after splenectomy. Patients should receive pneumocockvaccination and be informed of the lifelong risk of severe infections.