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Objective: Venous thromboembolism is one of the significant complications after elective and emergency splenectomy. Up to 35% of portal and splenic venous thromboembolism has been reported in the first two months after splenectomy for hematologic malignancy. Our objectives were to compare emergency and elective splenectomy and their complications, and to analyze the risks on the development of portal vein thrombosis (PVT). Material and Method: A total of 78 splenectomy cases performed between 2017-2023 and that had complete medical records were included in this study. Of these cases, 39 were emergency and 39 were elective procedures. The two groups were compared retrospectively for risks of PVT. Result: We found a significant relationship between the development of postoperative complications and the risk of PVT (p=0.004). The risk of developing PVT in emergency cases in the post-operative 2 weeks was significantly higher than elective cases (p=0.048). Shorter operation times, larger spleen sizes, lower platelet counts and malignancy in pathology results were found to be significantly in favor of elective cases (p=0.007, p=0.004, p<0.001, p=0.001, respectively). In emergency cases, the need for RBC transfusion and complications were more frequent (p<0.001, p=0.021). Conclusion: High-risk patients should be evaluated for prophylactic anticoagulation with low-molecular-weight heparin in the postoperative period and after discharge. Anticoagulation should be considered for emergency splenectomy, factoring in cost-benefit, and a low suspicion for venous thromboembolism should be maintained with timely investigation. In this sense, our study supports the existing data with its current results. [ABSTRACT FROM AUTHOR]

A 43-year-old-woman admitted to our department because of abdominal pain, abdominal distension, pain on both inner thighs and blurred vision lasting for 3 months. Pancytopenia and positive anti-double stranded DNA (dsDNA) antibodies were noted 5 years prior to her hospitalisation. On admission, the patient was diagnosed with systemic lupus erythematosus (SLE) with retinal vasculitis, panniculitis, cholecystitis and enteritis. The ultrasound test revealed a large amount of ascites, splenomegaly, a hypoechoic band in the liver, and portal hypertension with mildly elevated hepatic venous wedge pressure (15 mmHg). Liver biopsy showed no evidence of hepatitis, cholangitis or liver cirrhosis, leading to the diagnosis of idiopathic non-cirrhotic portal hypertension (INCPH). Prednisolone (PSL) at a daily dose of 50 mg and intravenous cyclophosphamide pulse therapy (IVCY) were initiated for SLE, while diuretics were administered for transudative ascites associated with INCPH. Although these symptoms temporarily improved, 2 months later, SLE and ascites effusion aggravated again, and portal vein thrombosis was confirmed by computed tomography. After increasing the dose of IVCY and adding an anticoagulant agent, all symptoms improved, allowing a reduction of the PSL dose. In the present case, the exacerbation of INCPH was associated with the exacerbation of SLE and the occurrence of portal thrombosis, suggesting an autoimmune and thrombotic mechanism of INCPH. On the other hand, splenomegaly, oesophageal varices, the hypoechoic band remained unchanged, suggesting the established organised INCPH was refractory to immunosuppressive agents. [ABSTRACT FROM AUTHOR]

Background Posttransplant vascular complications (PTVCs) have a significant effect on graft and patient after living-donor liver transplantation. We aim to determine the incidence of these complications, focusing on the effects of using synthetic venous grafts in vascular reconstruction, versus performing nongraft primary anastomosis. We did not use natural grafts in this study. Settings and design We collected the preoperative/intraoperative and postoperative data prospectively from 39 recipients/donors who underwent living-donor liver transplantation from November 2014 to August 2019 at the department of surgery in Al-Rajehy Liver Hospital, Assiut University. Patients and methods The vascular reconstruction of hepatic veins (HVs) in all patients was performed using synthetic vascular grafts, anastomosing the grafts' HVs (V5 and V8) to the recipients' inferior vena cava, whereas portal veins were reconstructed without grafts. PTVCs were analyzed over 3 months to determine their effect on recipients' morbidity and mortality, and their relation to the use of synthetic grafts in vascular reconstruction. Statistical analysis Data were analyzed via Statistical Package for the Social Science, version 22. We used Student t test or Mann–Whitney test for quantitative data, and χ2 test for qualitative data. Results Among 39 recipients, four (10.26%) died during the follow-up period. Vascular complications were the leading cause of death in three patients. Portal vein thrombosis had the highest incidence rates among the seven recipients having PTVCs, being developed in three (7.69%) of them. It represented the leading cause of death in one patient, whereas HVs thrombosis developed in one (2.56%) recipient, leading to his death on the seventh postoperative day. Conclusion PTVCs have significant effect on graft durability, as well as recipient's morbidity and mortality. The use of synthetic grafting in vascular reconstruction has shown particularly a significant negative effect. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC), one of the commonest primitive malignant tumors of the liver, is currently considered one of the very high life-threatening tumors. Surgery remains the treatment of choice of HCC and is indicated whenever possible. We present the case of a patient 66 years old, at which abdominal CT scan reveals the presence of HCC in segments 4 and 8, broken, and perisplenic and perihepatic fluid accumulation in the context of declining hemoglobin. Associate there is an incomplete picture of the portal convergence of 1.9 cm, with the lack of visualization of the left portal wreath. Even in the absence of the possibility of curative resection due to spontaneous rupture of the liver tumor, it is made a central necessity hepatectomy and subsegmentectomy 2 and 3 for the other three formations located at this level. Patient's postoperative course was favorable and he was discharged 11 days after surgery. Abdominal MRI performed 2 months postoperatively revealed the presence of multifocal recurrence. Patient dies at 6 months postoperatively. [ABSTRACT FROM AUTHOR]

Abstract: Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12‐month‐old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post‐operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post‐operative ultrasound identified reversed portal flow, finding a non‐anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re‐operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post‐operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation. [ABSTRACT FROM AUTHOR]

Background: Portomesenteric vein thrombosis (PMVT) is considered a rare and potentially fatal complication of bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures in the world. PMVT in LSG was first reported in 2009 by Berthet et al. in a thrombophilic patient. No data exist regarding the real prevalence of this complication specifically after LSG.Methods: We examined retrospectively all the clinical records of patients who underwent LSG for morbid obesity from January 2011 to December 2016. Moreover, we performed a literature search of PubMed, Medscape, and EMBASE databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: 2854 patients underwent LSG for morbid obesity from January 2011 to December 2016. The retrospective analysis of our records revealed only 1 case of PMVT. The 18 studies selected include 62 cases of PMVT after LSG with a prevalence of 0.52% (ranging from 0.2% to 1.81%) and a mortality rate of 1.61%.Conclusions: PMVT is an infrequent but not rare complication in patients who undergo LSG. Short-course antithrombotic prophylaxis (<10 days) could increase the risk of this complication. The authors recommend a postoperative prophylaxis with sodium enoxaparin 40 mg sc once a day for 4 weeks. PMVT mortality in patients who undergo LSG is lower than other causes of portal vein thrombosis (hepatic cirrhosis, tumors, myeloproliferative disorders, etc.) If risk factors for PMVT are present preoperatively, the authors recommend a prophylaxis with sodium enoxaparin 40 mg sc twice daily for 4 weeks. [ABSTRACT FROM AUTHOR]

The discovery of a portal cavernoma following a high digestive hemorrhage in a patient with a history of abortion iterative, is the witness of a chronic evolution of a portal thrombosis and it must impose an etiological investigation of a prothrombotic affection, unrecognized, in this case the antiphospholipid syndrome (Hughes' syndrome). Our observation describes the infra-hepatic obstacle (portal cavernoma), appreciates the extent of the porto-systemic collateral and objectives the multiple hilar and intra-spleen aneurysms, following a chronic and ancient thrombosis of the extra-hepatic portal system. The antiphospholipid syndrome is an acquired immune disorder with thrombogenic potential of polymorphic expression, which should be systematically considered first in any context of portal vein thrombosis, in a young woman with a history of abortions. From a therapeutic point of view, the stage of chronic portal thrombosis during the antiphospholipid syndrome impose prolonged anticoagulation, but this is far from being codified, clashing paradoxically with the potential haemorrhagic risks linked to portal hypertension and the many hyper-rate splenic aneurysms that can rupture. Splenic embolization with obturation and/or exclusion of aneurysms, as well as portal reperfusion surgery are theoretically justified, reserved for highly specialized centers. [ABSTRACT FROM AUTHOR]

Background: Four common causes of mesenteric ischemia identified: arterial embolism, arterial thrombosis, non-occlusive pathologies and mesenteric venous thrombosis (MVT). MVT is an uncommon cause of acute abdominal pain and accounts for 1 in 1000 emergency surgical laparotomies for acute abdomen. Case Presentation: A 31 year old male, previously healthy, with 72 hour history of generalized abdominal pain on examination with signs of peritonitis. He underwent a computed tomographic (CT) scan of the abdomen and pelvis, which demonstrated thrombosis of the portal, splenic and superior mesenteric veins. A laparotomy was performed, we found jejunal necrosis and a bowel resection was required. Hematologic, oncologic and autoimmune studies were performed and all of them were negative. Discussion: Venous thrombosis is almost always secondary to other pathologies. The principle ones are: hypercoagulability and occult neoplasia. The clinical presentation is non-specific. To make a diagnosis one can use: a Doppler ultrasound, a CT angiography, a magnetic resonance and a catheter angiography. The available treatments for acute mesenteric ischemia are: endovascular procedures, bypass surgery, anticoagulation and a laparotomy to treat visceral complications. Conclusion: Even if this is an uncommon pathology, physicians need to be aware of pathophysiology, diagnosis and treatment of acute mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Objective This report discusses the role of both congenital and acquired risk factors in the pathogenesis of portal vein thrombosis (PVT). Study Design We describe the clinical management and treatment of PVT in a preterm newborn with a homozygous mutation of the methylenetetrahydrofolate reductase (MTHFR) and plasminogen activator inhibitor-1 (PAI-1) genes and sepsis by Candida para psilosis. Results Although literature data suggest a minor role of genetic factors in thrombophilia in the case of only one mutation, we hypothesize that combined thrombophilic genetic defects may have a cumulative effect and significantly increase the thrombotic risk. Conclusion It could be appropriate to include more detailed analyses of procoagulant and fibrinolytic factors in the diagnostic workup of neonatal thrombosis, also through the investigation of genetic polymorphisms. The anticoagulant therapy and the removal of concurrent risk factors remain basic steps for the adequate management and prevention of complications. [ABSTRACT FROM AUTHOR]

Background: Patients with Myeloproliferative Neoplasms - (MPN) have a high risk of thrombotic complications. Portal vein thrombosis is a severe complication, which in many cases, appears at the onset of the disease; the risk factors are related to the presence of qualitatively altered thrombocytes and leucocytes, leading to their activation and appearance of leukocytes-plateletaggregates; anomalies of portal vein endothelial cells are also implicated. The presence of JAK2V617F mutation increases the risk for splahnic thrombosis. Methods and results: We present three patients with portal vein thrombosis and Budd Chiari syndrome, who were further diagnosed with MPN- the thrombosis was the onset event of the disease. Conclusion: Patients were diagnosed with thrombosis of the portal vein before being diagnosed with MPN. Splenectomy was not associated with risk of thrombosis for the two cases in which it was performed; for one case, splenectomy was a therapeutic method to resolve portal hypertension. All patients had homozygous JAK2 mutation, which is associated in recent studies with increased risk of portal, mesenteric thrombosis. The high number of platelet was difficult to control for all patients. Bone marrow biopsy and determination of JAK status are valuable investigations for patients who have splenoportal thrombosis, with no apparent identifiable cause. [ABSTRACT FROM AUTHOR]

Patent ductus venosus (PDV) is a rare condition, which usually presents secondary to hepatic atrophy and hepatic failure. We have treated eight cases of PDV, all with hypergalactosemia and hyperbilirubinemia. Ultrasonography and three-dimensional computed tomography demonstrated communication between the portal vein and the inferior vena cava. Of the eight PDV cases, three from the older age group (ages 9, 11, and 14 years) had high-density lesions in their brain nucleus, and one case (age 19 years) had undergone prior Kasai portoenterostomy for biliary atresia. Six PDV patients underwent ligation of PDV and the remaining two cases underwent partial banding of PDV with intraoperative monitoring to maintain portal vein pressure (PVP) under 30 cm H(2)O. Improvement of the intrahepatic portal vein flow was achieved by ligation or banding of PDV. Postoperatively, serum galactose and bilirubin fell to normal ranges, but portal thrombus occurred postoperatively in the first case. We subsequently administered postoperative anticoagulation in the remaining cases and experienced no major complications. These results suggest that PDV ligation and banding are effective surgical approaches for patients with PDV. Close postoperative monitoring to avoid portal thrombus is imperative in these cases. [ABSTRACT FROM AUTHOR]

Abstract: Introduction. – The cytomegalovirus (CMV) infection is most often asymptomatic. The grave forms concern the immunocompromised patients. We report a new case pf acute CMV hepatitis complicated with portal thrombosis in an immunocompetent patient. Exegesis. – A 29 year old man has presented a CMV hepatitis proved by the presence of pp65 protein and the viral DNA in serum. This infection was complicated by a portal thrombosis and the evolution was rapidly favourable under anticoagulant treatment. Eleven cases of major thrombosis complicating acute CMV infection in immunocompetent patients were previously reported in the English and French literature. The absence of local and general cause, the remission without anticoagulation, the elevated risk of thrombosis in both HIV and CMV seropositive patients, and in CMV seropositive renal transplant patients suggest a causal relation. Various pathogenic hypotheses were raised: presence of antiphospholipid antibodies, absent in our case, procoagulant phenotype induction of infected endothelial cells, proliferation induction of smooth cells. Conclusion. – The acute CMV infection can be considered such as a possible cause of major thrombosis. [Copyright &y& Elsevier]

Robles R, Fernández JÁ, Hernández Q, Marín C, Ramírez P, Sánchez-Bueno F, Luján JA, Rodríguez JM, Acosta F, Parrilla P. Eversion thromboendovenectomy in organized portal vein thrombosis during liver transplantation. Clin Transplant 2004: 18: 79–84. © Blackwell Munksgaard, 2004 Portal thrombosis is no longer considered a contraindication for transplantation because of the technical experience acquired in the field of liver transplantation and the development of various surgical techniques. All the same, the results obtained in portal thrombosis patients are at times suboptimal, and the surgical technique used (thromboendovenectomy or veno-venous bypass) is also controversial. Between May 1988 and December 2001, 455 liver transplants were performed, of which 32 (7%) presented portal vein thrombosis. Of these, eight belonged to the first 227 transplants (group I), and 24 to the other 228 (group II). Of the 32 cases with portal thrombosis, 20 (62%) were type Ib, seven (22%) type II/III and five (16%) type IV. Twenty-two were males (69%), with a mean age of 50 yr (range: 30–70 yr); the thrombosis in all cases developed over a cirrhotic liver: 15 cases of an ethanolic origin, 11 because of hepatitis C virus, two cases of autoimmune aetiology, one case of primary biliary cirrhosis, one case because of hepatitis B virus and two cases of a cryptogenic origin. Five cases had a history of surgical treatment for portal hypertension. The surgical method in all cases consisted of an eversion thromboendovenectomy (ETEV) under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Once re-canalization was achieved, we performed local heparinization and end-to-end portal anastomosis. In no case was systemic post-operative heparinization performed. In the 32 cases in which thrombectomy was attempted it was achieved in 31 of them (96%), failing only in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis re-thrombosed. The 5-yr survival rate of the patients in the series was 69%, with 10 patients dying, of whom only two from causes related to the thrombosis and the thrombosis treatment, both with type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation is controversial and depends on its extension and the experience of the surgeon. In our experience, ETEV resolves most thromboses (types I, II and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal haemitransposition. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal transit studies have shown contradictory results in patients with portal hypertension. We have studied gastric emptying, small-bowel transit and colonic transit in patients with portal hypertension. The association between small-bowel bacterial overgrowth and gastrointestinal transit was assessed. Methods: Sixteen patients (6 females) with portal hypertension and esophageal varices were included. A newly developed radiological procedure was used to measure gastrointestinal transit during one visit. Variceal pressure was measured and culture of small-bowel aspirate was used to diagnose small-bowel bacterial overgrowth. The results were compared to results obtained in 83 healthy subjects. Results: Half gastric emptying time in male patients was 3.8 (0.9-5.8) h versus 2.5 (0.4-4.0) h in healthy males (median and percentile 10-90; P < 0.05). Small-bowel residence time in male patients was 5.9 (2.0-13.7) h versus 3.2 (1.5-6.0) h in healthy males ( P < 0.05). Small-bowel residence time in patients with bacterial overgrowth was significantly longer than in patients without bacterial overgrowth. Small-bowel residence time was also significantly longer in male patients with alcoholic cirrhosis as compared to male patients with other causes of portal hypertension. Colonic transit in all patients and gastric emptying and small-bowel transit in female patients were not significantly different from healthy subjects. Conclusion: Etiology of liver disease and gender may influence transit in patients with portal hypertension. Small-bowel bacterial overgrowth was associated with delayed small-bowel transit. [ABSTRACT FROM AUTHOR]

A 64-year-old man, who came to us with diarrhea, presented with ectodermal changes such as hyperpigmentation, alopecia, and onychatrophy, and was affected by polyposis in the colorectum and stomach. The polyps were histologically consistent with those in Cronkhite­Canada syndrome (CCS). Interestingly, the patient also had colon cancer, as well as portal thrombosis and a high concentration of antinuclear antibody. Treatment with prednisolone ameliorated the symptoms and the gastrointestinal polyposis, while the cancer was successfully treated with a hemicolectomy. Six months after the surgery, the patient developed nephropathy, with nephrotic-range proteinuria, without recurrence of the cancer. The biopsied renal specimen showed membranous glomerulonephritis. This is a rare case of CCS associated with various complications such as colon cancer, portal vein thrombosis, a high titer of antinuclear antibodies, and membranous glomerulonephritis. Although the pathogenesis of CCS is essentially unknown, these complications might have been indicative of an underlying immunological abnormality. [ABSTRACT FROM AUTHOR]

Portal cavernoma is a network of veins whose caliber, initially millimetric or microscopic, is increased and which contain hepatopedal portal blood. It results from occlusion, thrombotic and always chronic, of the extra-hepatic portal system. Diagnosis is mainly done by imaging. Clinical signs of portal cavernoma are usually related to extra-hepatic portal hypertension (hematemesis due to rupture of oeso-gastric varices, splenomegaly, rectal bleeding from ano-rectal varices, growth retardation in children) and sometimes to the cause of portal hypertension (abdominal pain, venous bowel infarction). Occurrence of portal thrombosis is often the conjunction of a local cause and a prothrombotic disorder which must be systematically detected. Biliary consequences of cavernoma are related to compression of common bile duct and are usually asymptomatic. In case of jaundice or cholangitis, portal decompression by portosystemic shunt can be performed to treat both biliary symptoms and portal hypertension. [Copyright &y& Elsevier]

Portal vein thrombosis may complicate splenectomy in patients with hemolytic anemia and myeloproliferative disease, whereas the frequency of portal vein thrombosis in case of trauma is not defined. A case of right portal vein thrombosis after splenectomy for trauma is reported in this paper. Hematologic workup did not reveal an underlying platelet or coagulation disorder. The patient was promptly anti-coagulated with complete recanalization of the portal vein. We conclude that mild symptoms, like abdominal pain and fever, after splenectomy should be investigated with a color Doppler ultrasonography to confirm or rule out a diagnosis of portal thrombosis and to anti-coagulate the patient with thrombosis, thus preventing bowel infarction and secondary portal hypertension. Routine postoperative color Doppler might also be justified in all postsplenectomy patients (without hematologic diseases) for early detection of a portal vein thrombosis. [ABSTRACT FROM AUTHOR]