Portal system thrombosis after hematological splenectomy.

Venous thrombosis of the portal system following splenectomy for haematological diseases is uncommon, being reported with an incidence of 0,2 to 6 %. Diagnosis may be difficult and the clinical presentation varies greatly. We report 4 cases, included in a consecutive series of 350 splenectomies for hematological diseases. Case 1 : a man of 22 years, operated on for autoimmune hemolytic anemia developed severe and generalized abdominal pain 20 days after splenectomy. The coeliac arteriography showed a thrombosis of the portal system. The laparotomy revealed segmentary small bowel necrosis. Outcome after intestinal resection was uneventful. Case 2 : a man of 56 years, operated on for essential thrombocythemia had the laboratory findins of acute hepatic failure 28 days after splenectomy. Doppler ultrasonography revealed a portal vein thrombosis. He was treated with heparin. Case 3 : a man of 69 years, operated on for acquired idiopathic anemia, developed asthenia and fever 23 days after splenectomy. The ultrasonography showed a portal vein thrombosis. He was successfully treated with heparin. Case 4 : a man of 20 years, operated on for Minkowsky-Chauffard hemolytic anemia developed a severe and generalized abdominal pain and fever 13 days after splenectomy. The CT-scan showed a thrombosis of the portal system. Outcome after thrombectomy and regional thrombolysis was uneventful. The aim of this presentation is to review the pathophysiological diagnosis, therapeutic and prophylactic aspects of this serious complication of splenectomy.