Skip to main content
SpringerLink
Log in

Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Idiopathic portal hypertension (IPH) is considered to be closely related to portal vein thrombosis (PVT). The aim of this study was to clarify the incidence, clinical characteristics, and outcomes of PVT in patients with IPH after splenectomy.

Methods

We investigated the rates, clinical characteristics, and outcomes of PVT in 18 patients who underwent splenectomy for IPH, during a mean follow-up period of 152 ± 83 months.

Results

Seven of the 18 patients (39%) experienced gastrointestinal bleeding, which was from the varices in 4. Eight patients (44%) had PVT, and the mean interval until its detection after splenectomy was 22 ± 41 months. The cumulative gastrointestinal bleeding rates 5, 10, and 15 years after surgery were 24%, 31%, and 41%, respectively. The cumulative survival rates 5, 10, and 15 years after surgery were 94%, 74%, and 65%, respectively. There were no significant differences in the cumulative gastrointestinal bleeding and survival rates between patients with and those without PVT.

Conclusion

Despite the high incidence of PVT in IPH patients postsplenectomy, it may not be related to their gastrointestinal bleeding or prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Okuda K, Kono K, Ohnishi K, Kimura K, Omata M, Koen H, et al. Clinical study of eighty-six cases of idiopathic portal hypertension and comparison with cirrhosis with splenomegaly. Gastroenterology 1984;86:600–610.

    PubMed  CAS  Google Scholar 

  2. Ichimura S, Sasaki R, Takemura Y, Iwata H, Obata H, Okuda H, et al. The prognosis of idiopathic portal hypertension in Japan. Intern Med 1993;32:441–444.

    Article  PubMed  CAS  Google Scholar 

  3. Tsuneyama K, Ohba K, Zen Y, Sato Y, Niwa H, Minato H, et al. A comparative histological and morphometric study of vascular changes in idiopathic portal hypertension and alcoholic fibrosis/cirrhosis. Histopathology 2003;43:55–61.

    Article  PubMed  CAS  Google Scholar 

  4. Tsuneyama K, Kouda W, Nakanuma Y. Portal and parenchymal alterations of the liver in idiopathic portal hypertension: a histological and immunohistochemical study. Pathol Res Pract 2002;198:597–603.

    Article  PubMed  Google Scholar 

  5. Nakanuma Y, Hoso M, Sasaki M, Terada T, Katayanagi K, Nonomura A, et al. Histopathology of the liver in non-cirrhotic portal hypertension of unknown aetiology. Histopathology 1996;28:195–204.

    Article  PubMed  CAS  Google Scholar 

  6. Benhamou JP, Valla DC. Intrahepatic portal hypertension. In: Bircher J, Benhamou JP, McIntyre N, Rizzetto M, Rodes J, editors. Oxford textbook of clinical hepatology. 2nd ed. Oxford: Oxford University Press; 1999. p. 661–670.

    Google Scholar 

  7. Hillaire S, Valla DC, Lebrec D. Non cirrhotic portal hypertension. Clin Liver Dis 1997;1:1223–1240.

    Article  Google Scholar 

  8. Kage M, Arakawa M, Fukuda K, Kojiro M. Pathomorphologic study on the extrahepatic portal vein in idiopathic portal hypertension. Liver 1990;10:209–216.

    PubMed  CAS  Google Scholar 

  9. Okudaira M, Ohbu M, Okuda K. Idiopathic portal hypertension and its pathology. Semin Liver Dis 2002;22:59–71.

    Article  PubMed  Google Scholar 

  10. Eguchi A, Hashizume M, Kitano S, Tanoue K, Wada H, Sugimachi K. High rate of portal thrombosis after splenectomy in patients with esophageal varices and idiopathic portal hypertension. Arch Surg 1991;126:752–755.

    PubMed  CAS  Google Scholar 

  11. Okuda K, Nakashima T, Kameda H Sugiura M, Ohnishi K, Kobayashi M. Idiopathic portal hypertension: a national study. In: Brunner, H, Thaler, H, editors. Hepatology: a festschrift for Hans Popper. New York: Raven; 1985:95–108.

    Google Scholar 

  12. Hassab MA. Gastroesophageal decongestion and splenectomy in the treatment of esophageal varices in bilharzial cirrhosis: further studies with a report of 355 operations. Surgery 1967;61:169–176.

    PubMed  CAS  Google Scholar 

  13. Kitano S, Baatar A, Bandoh T, Yoshida Y, Tsuboi S, Matsumoto T. Transvenous sclerotherapy for huge oesophagogastric varices using open injection sclerotherapy. Br J Surg 2000;87:1–5.

    Article  Google Scholar 

  14. Banti G. Splenomegalie mit Leberizirrhose. Beitrage zur pathologichen. Anat Allgemeinea Pathol 1889;24:21–33.

    Google Scholar 

  15. Boyer JL, Sen Gupta KP, Biswas SK, Pal NC, Basu Mallick KC, Iber FL, et al. Idiopathic portal hypertension. Comparison with the portal hypertension of cirrhosis and extrahepatic portal vein obstruction. Ann Intern. Med 1967;66:41–68.

    PubMed  CAS  Google Scholar 

  16. Villeneuve JP, Huet PM, Joly JG, Marleau D, Côté J, Légaré A, et al. Idiopathic portal hypertension. Am J Med 1976;61:459–464.

    Article  PubMed  CAS  Google Scholar 

  17. Sama SK, Bhargava S, Gopi-Nath N, Talwar JR, Nayak NC, Tandon BN, et al. Non-cirrhotic portal fibrosis. Am J Med 1971;51:160–171.

    Article  PubMed  CAS  Google Scholar 

  18. Levison DA, Kingham JG, Dawson AM, Stansfeld AG. Slow cirrhosis or no cirrhosis? A lesion causing benign intrahepatic portal hypertension. J Pathol 1982;137:253–272.

    Article  PubMed  CAS  Google Scholar 

  19. Wanless IE. Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules. Hepatology 1990;11:787–797.

    Article  PubMed  CAS  Google Scholar 

  20. Kameda H. Obliterative portal venopathy: a comparison study of 184 cases of extrahepatic portal obstruction and 469 cases of idiopathic portal hypertension. J Gastroenterol Hepatol 1986;1:139–149.

    Article  Google Scholar 

  21. Dhiman RK, Chawla Y, Vasishta RK, Kakkar N, Dilawari JB, Trehan MS, et al. Non-cirrhotic portal fibrosis (idiopathic portal hypertension): experience with 151 patients and a review of the literature. J Gastroenterol Hepatol 2002;17:6–16.

    Article  PubMed  Google Scholar 

  22. Sciot R, Staessen D, Van Damme B, Van Steenbergen W, Fevery J, De Groote J, et al. Incomplete septal cirrhosis: histopathological aspects. Histopathology 1988;13:593–603.

    Article  PubMed  CAS  Google Scholar 

  23. Nevens F, Staessen D, Sciot R, Van Damme B, Desmet V, Fevery J, et al. Clinical aspects of incomplete septal cirrhosis in comparison with macronodular cirrhosis. Gastroenterology 1994;106:459–463.

    PubMed  CAS  Google Scholar 

  24. Tomikawa M, Akahoshi T, Sugimachi K, Ikeda Y, Korenaga D, Takenaka K, et al. An assessment of surgery for portal hypertensive patients performed at a single community hospital. Surg Today 2010:40:620–625.

    Article  PubMed  Google Scholar 

  25. Bernard PH, Le Bail B, Cransac M, Barcina MG, Carles J, Balabaud C, et al. Progression from idiopathic portal hypertension to incomplete septal cirrhosis with liver failure requiring liver transplantation. J Hepatol 1995;22:495–499.

    Article  PubMed  CAS  Google Scholar 

  26. Krasinskas AM, Eghtesad B, Kamath PS, Demetris AJ, Abraham SC. Liver transplantation for severe intrahepatic noncirrhotic portal hypertension. Liver Transpl 2005;11:627–634.

    Article  PubMed  Google Scholar 

  27. Ogren M, Bergqvist D, Björck M, Acosta S, Eriksson H, Sternby NH. Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 2006;12:2115–2119.

    PubMed  Google Scholar 

  28. Condat B, Pessine T, Helene DM, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis, increased recognition and frequent recanalisation on anticoagulant therapy. Hepatology 2000;32:466–470.

    Article  PubMed  CAS  Google Scholar 

  29. Baril N, Wren S, Radin R, Ralla P, Stain S. The role of anticoagulation in pylephlebitis. Am J Surg 1996;172:449–452.

    Article  PubMed  CAS  Google Scholar 

  30. Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007;102:2464–2670.

    Article  PubMed  Google Scholar 

  31. Dolorich LR, Ginsberg JS, Douketis JD, Holbrook AM, Chealig A. metaanalysis comparing low molecular wt heparin with unfractionated heparin in treatment of venous thromboembolism examining some unanswered questions regarding location of treatment product use and dosing frequency. Arch Intern Med 2000;160:181–188.

    Article  Google Scholar 

  32. Chawla Y, Duseja A, Dhiman RK. Review article: the modern management of portal vein thrombosis. Aliment Pharmacol Ther 2009;30:881–894.

    Article  PubMed  CAS  Google Scholar 

  33. Hillaire S, Bonte E, Denninger MH, Casadevall N, Cadranel JF, Lebrec D, et al. Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients. Gut 2002;51:275–280.

    Article  PubMed  CAS  Google Scholar 

  34. Sawada S, Sato Y, Aoyama H, Harada K, Nakanuma Y. Pathological study of idiopathic portal hypertension with an emphasis on cause of death based on records of Annuals of Pathological Autopsy Cases in Japan. J Gastroenterol Hepatol 2007;22:204–209.

    Article  PubMed  Google Scholar 

  35. Matsutani S, Maruyama H, Akiike T, Kobayashi S, Yoshizumi H, Okugawa H, et al. Study of portal vein thrombosis in patients with idiopathic portal hypertension in Japan. Liver Int 2005;25:978–983.

    Article  PubMed  Google Scholar 

  36. Bilodeau M, Aubry MC, Houle R, Burnes PN, Ethier C. Evaluation of hepatocyte injury following partial ligation of the left portal vein. J Hepatol 1999;30:29–37.

    Article  PubMed  CAS  Google Scholar 

  37. Parikh S, Shah R, Kapoor P. Portal vein thrombosis. Am J Med 2010;123:111–119.

    Article  PubMed  Google Scholar 

  38. Hashizume M, Kitano S, Yamaga H, Wada H, Sugimachi K. Eradication of oesophageal varices recurring after portal non-decompressive surgery by injection sclerotherapy. Br J Surg 1990;77:940–943.

    Article  PubMed  CAS  Google Scholar 

  39. Hashizume M, Kitano S, Koyanagi N, Tanoue K, Ohta M, Wada H, et al. Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: a nine-year prospective study. Hepatology 1992;15:69–75.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery I, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan

    Teijiro Hirashita, Masayuki Ohta, Seiichiro Kai, Takashi Masuda, Hidetoshi Eguchi, Yukio Iwashita, Tadashi Ogawa & Seigo Kitano

Authors
  1. Teijiro Hirashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayuki Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seiichiro Kai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Masuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hidetoshi Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yukio Iwashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tadashi Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seigo Kitano
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hirashita, T., Ohta, M., Kai, S. et al. Implications of portal vein thrombosis after splenectomy for patients with idiopathic portal hypertension. Surg Today 41, 1475–1480 (2011). https://doi.org/10.1007/s00595-010-4523-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-010-4523-6

Key words

Search

Navigation