Trombosis venosa portal posesplenectomía por anemia hemolítica. Reporte de caso y revisión de la literatura / Case Report of Venous Portal Vein Thrombosis after Splenectomy to Treat Hemolytic Anemia and Review of the Literature

Resumen La trombosis venosa portal secundaria a esplenectomía es una patología frecuente. En pacientes llevados a este procedimiento por anemia hemolítica, varios factores de riesgo locales y sistémicos contribuyen a su presentación. Esta complicación es potencialmente mortal y ha existido gran discusión sobre las intervenciones adecuadas para su prevención y tratamiento. Frecuentemente se desconoce esta alteración. Se presenta un caso y se hace una revisión del tema.

Abstract Portal vein thrombosis is a frequently occurring pathology following splenectomy. Several local and systemic risk factors contribute to its occurrence among patients who undergo this procedure to treat hemolytic anemia. This potentially fatal complication has caused great discussion about appropriate interventions for its prevention and treatment. Frequently this alteration is undetected. We present a case and review the topic.

Effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis / 器官移植

Objective To investigate the effect of preoperative portal venous thrombosis on liver transplantation for patients with end-stage liver cirrhosis.Methods Clinical data of 182 patients with end-stage liver cirrhosis undergoing liver transplantation at the Organ Transplantation Center of the Third Affiliated Hospital,Sun Yat-sen University from January 2007 to December 2011 were retrospectively studied.Thirteen patients complicated with portal venous thrombosis (3 patients were in Yerdel gradeⅠ,6 were in grade Ⅱ,2 were in grade Ⅲ and 2 were in grade Ⅳ)were divided into the portal venous thrombosis group.Other 169 patients without portal venous thrombosis were divided into the control group. The intra-operative and postoperative conditions of patients were compared between two groups.Results Compared with the control group,there were longer operation time,more intra-operative blood loss in the portal venous thrombosis group and the patient with Yerdel grade Ⅲ-Ⅳ.There was significant difference (both in P <0.05).At one month after transplantation,one patient (8%)in the portal venous thrombosis group and three patients (2%)in the control group developed portal venous thrombosis,and there was significant difference (P <0.05).Three-year survival rate of the portal venous thrombosis group was 46% (6 /13)and that of the control group was 84%(142 /169),and there was significant difference (P <0.05).Conclusions Portal venous thrombosis of gradeⅢ and Ⅳ may significantly increase the difficulty and risks of liver transplantation.However,the good curative effect may also be obtained only when the portal venous thrombosis is strictly assessed ,and the rational portal venous reconstruction method is used during the operation.