Systemic thromboembolic complications after laparoscopic splenectomy for idiopathic thrombocytopenic purpura in comparison to open surgery in the absence of anticoagulant prophylaxis

Idiopathic thrombocytopenic purpura [ITP] in adults has a chronic course and may necessitate splenectomy. The current study was undertaken to study the systemic thromboembolic complications of laparoscopic splenectomy [LS] versus open splenectomy [OS] in patients with ITP at two large referral hospitals. We conducted a retrospective analysis of 49 patients who underwent splenectomy [21 LS and 28 OS] for primary/relapsing refractory ITP between June 1995 and November 2004. Clinically and/or radiologically confirmed deep venous thrombosis [DVT] and/or pulmonary embolism [PE] were assessed within 2 weeks before and after splenectomy. None had prophylactic anticoagulants immediately after surgery. Follow up of those who developed complications continued for at least 2 additional years to assess for contributing factors that may have been masked at the time of occurrence. Two [9.5%] LS group had acute PE within 5 days of LS and their platelet count reached 500 +/- 103/ micro L within 4 days and 1000 +/- 103/ micro L within 7 days after surgery. Three conversions to OS occurred; none had VTE. DVT occurred in 3 patients [10.7%] in the OS group; none were life threatening. There were no deaths. Life-threatening venous thromboembolic events are serious complications after LS and OS for ITP patients if prophylactic anticoagulants are not administered. Patients at risk are those who both have an exponential rise of the platelet count, although factors other than the platelet count may be contributing in OS. Postsplenectomy, ITP should be considered as a thrombophilic condition and studies of additional measures to prevent such events are warranted

Value of abdominal ultrasonography and doppler in assessment of portal hypertension in children

This study was carried out to find a relation between ultrasonographic and Doppler findings of portal hypertension and grading of Esophageal varices as detected by upper GIT endoscopy. 24 children suffering from portal hypertension were subjected to full clinical examination laboratory investigations, liver biopsy, upper GIT endoscopy and abdominal US. Their ultrasonographic and Doppler data were compared to those of a control group consisting of 20 healthy children of matched age and sex. According to endoscopic grading of OV, patients were divided into two groups, mild and severe. The severe group was again subdivided into bleeders and non-bleeders for further analysis. Ultrasonographic parameters as MPV-d, sp-MPV, sp-RPV, sp-LPV, SV-d, long axis of the spleen and omental thickness were all significantly different from those of controls. Among patients of the severe group, bleeders were significantly different from non-bleeders as regards SV- d, OT and sp-splenorenal. To predict severity and onset of bleeding of OV in patients with PH, a score was developed. Accordingly, patients having scores above seven are at risk of hematemesis and might be considered for prophylactic regimens