Portal, Mesenteric, and Splenic Vein Thrombosis Following a Splenectomy for Myeloid Metaplasia

ABSTRACT

Postsplenectomy portal, mesenteric, or splenic vein thrombosis is a rare, but often fatal, complication which may be related to thrombocytosis, abnormal platelet function, and stasis in the splenic vein remnant. In the recent literature, there have been reports concerning portal and mesenteric venous thrombosis complicating splenectomy for hematologic disoders. Many thrombosis have occurred following splenectomy for myeloid metaplasia and have been associated with postsplenectomy thrombocytosis. The vast majority of patients with idiopathic myelofibrosis remain incurable, and current management is directed towards alleviating the symtoms and improving the quality of life. The splenectomy for myeloid metaplasia is palliative and carries a significant morbidity, and mortality. Under these circumstances, repeated assessment of indications, morbidity and duration of patient survival is of importance to physi cians and surgeons participating in the management of myeloid metaplasia. Because of the significant incidence and high mortality of postsplenectoimy thrombosis in myeloid metaplasia, the prophylactic use of anticoagulant agents and antiplatelet drugs and long-term maintenance therapy are necessary. At the time of the splenectomy, an attempt should be made to ligate the splenic vein as close as possible to its junction with the idiopathic myelofibrosis. A small bowel resection is indicated if focal, persistent paralytic ileus of mecanical obstruction occurs.