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World Journal of Surgery

, Volume 38, Issue 4, pp 976–984 | Cite as

Postoperative Portomesenteric Venous Thrombosis: Lessons Learned From 1,069 Consecutive Laparoscopic Colorectal Resections

  • Marco E. AllaixEmail author
  • Mukta K. Krane
  • Marco Zoccali
  • Konstantin Umanskiy
  • Roger Hurst
  • Alessandro Fichera
Article

Abstract

Background

Portomesenteric venous thrombosis (PVT) is a known complication after open and laparoscopic colorectal (LCR) surgery. Risk factors and the prognosis of PVT have been poorly described.

Methods

This study is a retrospective analysis of a prospectively collected database. Patients with new-onset postoperative abdominal pain were evaluated with a computed tomography scan of the abdomen. Patients found to have PVT were analyzed. A multivariate analysis was performed to identify predictors of PVT.

Results

A total of 1,069 patients undergoing LCR surgery for inflammatory bowel disease (IBD) or nonmetastatic cancer between June 2002 and June 2012 were included. Altogether, 37 (3.5 %) patients experienced symptomatic postoperative PVT. On univariate analysis, IBD (p < 0.001), ulcerative colitis (p = 0.016), preoperative therapy with steroids (p = 0.008), operative time ≥220 min (p = 0.004), total proctocolectomy (TPC) (p < 0.001), ileoanal pouch anastomosis (p = 0.006), and postoperative intraabdominal septic complications (p < 0.001) were found to be significant risk factors. By multivariate analysis, TPC (p = 0.026) and postoperative intraabdominal septic complications (p < 0.001) were independent predictors of PVT. In the PVT group, postoperative length of stay was longer (14.8 vs. 7.4 days, p < 0.001). Of the patients evaluated with a hematologic workup, 72.7 % were found to have a hypercoagulable condition. All patients were managed with oral anticoagulation for at least 6 months. No death or complications related to PVT occurred.

Conclusions

PVT is a potentially serious complication that is more likely to occur after TPC and in the presence of postoperative intraabdominal septic complications, particularly in patients with a coagulation disorder. Prompt diagnosis and treatment with oral anticoagulation are recommended to avoid long-term sequelae.

Keywords

Inflammatory Bowel Disease Ulcerative Colitis Inflammatory Bowel Disease Patient Portal Vein Thrombosis Stoma Creation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Condat B, Valla D (2006) Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol 3:505–515PubMedCrossRefGoogle Scholar
  2. 2.
    Ogren M, Bergqvist D, Wählander K et al (2006) Portal vein thrombosis: prevalence, patient characteristics and lifetime risk—a population study based on 23,796 consecutive autopsies. World J Gastroenterol 12:2115–2119PubMedGoogle Scholar
  3. 3.
    Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688PubMedCrossRefGoogle Scholar
  4. 4.
    Remzi FH, Fazio VW, Oncel M et al (2002) Portal vein thrombi after restorative proctocolectomy. Surgery 132:655–662PubMedCrossRefGoogle Scholar
  5. 5.
    Fichera A, Cicchiello LA, Mendelson DS et al (2003) Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 46:643–648PubMedCrossRefGoogle Scholar
  6. 6.
    Ball CG, MacLean AR, Buie WD et al (2007) Portal vein thrombi after ileal pouch-anal anastomosis: its incidence and association with pouchitis. Surg Today 37:552–557PubMedCrossRefGoogle Scholar
  7. 7.
    James AW, Rabl C, Westphalen AC et al (2009) Portomesenteric venous thrombosis after laparoscopic surgery: a systematic review. Arch Surg 144:520–526PubMedCrossRefGoogle Scholar
  8. 8.
    Valla DC, Condat B (2000) Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 32:865–871PubMedCrossRefGoogle Scholar
  9. 9.
    Sheen CL, Lamparelli H, Milne A et al (2000) Clinical features, diagnosis and outcome of acute portal vein thrombosis. Q J Med 92:531–534CrossRefGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Bradbury MS, Kavanagh PV, Bechtold RE et al (2002) Mesenteric venous thrombosis: diagnosis and noninvasive imaging. Radiographics 22:527–541PubMedCrossRefGoogle Scholar
  12. 12.
    Pieters PC, Miller WJ, DeMeo JH (1997) Evaluation of the portal venous system: complementary roles of invasive and noninvasive imaging strategies. Radiographics 17:879–895PubMedCrossRefGoogle Scholar
  13. 13.
    Baker ME, Remzi F, Einstein D et al (2003) CT depiction of portal vein thrombi after creation of ileal pouch-anal anastomosis. Radiology 227:73–79PubMedCrossRefGoogle Scholar
  14. 14.
    Jakimowicz J, Stultiëns G, Smulders F (1998) Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12:129–132PubMedCrossRefGoogle Scholar
  15. 15.
    Schäfer M, Krähenbühl L (2001) Effect of laparoscopy on intra-abdominal blood flow. Surgery 129:385–389PubMedCrossRefGoogle Scholar
  16. 16.
    Epstein RM, Wheeler HO, Frumin MJ et al (1961) The effect of hypercapnia on estimated hepatic blood flow, circulating splanchnic blood volume, and hepatic sulfobromophthalein clearance during general anesthesia in man. J Clin Invest 40:592–598PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Koutroubakis IE (2000) Role of thrombotic vascular risk factors in inflammatory bowel disease. Dig Dis 18:161–167PubMedCrossRefGoogle Scholar
  18. 18.
    Bernstein CN, Blanchard JF, Houston DS et al (2001) The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost 85:430–434PubMedGoogle Scholar
  19. 19.
    Wyshock E, Caldwell M, Crowley JP (1988) Deep venous thrombosis, inflammatory bowel disease, and protein S deficiency. Am J Clin Pathol 90:633–635PubMedGoogle Scholar
  20. 20.
    Jackson LM, O’Gorman PJ, O’Connell J et al (1997) Thrombosis in inflammatory bowel disease: clinical setting, procoagulant profile and factor V Leiden. Q J Med 90:183–188CrossRefGoogle Scholar
  21. 21.
    Aichbichler BW, Petritsch W, Reicht GA et al (1999) Anti-cardiolipin antibodies in patients with inflammatory bowel disease. Dig Dis Sci 44:852–856PubMedCrossRefGoogle Scholar
  22. 22.
    Guedon C, Le Cam-Duchez V, Lalaude O et al (2001) Prothrombotic inherited abnormalities other than factor V Leiden mutation do not play a role in venous thrombosis in inflammatory bowel disease. Am J Gastroenterol 96:1448–1454PubMedCrossRefGoogle Scholar
  23. 23.
    Hall TC, Garcea G, Metcalfe M et al (2011) Management of acute non-cirrhotic and non-malignant portal vein thrombosis: a systematic review. World J Surg 35:2510–2520. doi: 10.1007/s00268-011-1198-0 PubMedCrossRefGoogle Scholar
  24. 24.
    Condat B, Pessione F, Helene Denninger M et al (2000) Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470PubMedCrossRefGoogle Scholar
  25. 25.
    Sheen CL, Lamparelli H, Milne A et al (2000) Clinical features, diagnosis and outcome of acute portal vein thrombosis. Q J Med 93:531–534CrossRefGoogle Scholar
  26. 26.
    Sogaard KK, Astrup LB, Vilstrup H et al (2007) Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol 7:34PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Plessier A, Murad S, Hernandez-Guerra M et al (2007) A prospective multicentric follow-up study on 105 patients with acute portal vein thrombosis (PVT): results from the European network for vascular disorders of the liver (EN-VIE). Hepatology 46(suppl 1):310Google Scholar
  28. 28.
    Amitrano L, Guardascione MA, Scaglione M et al (2007) Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 102:2464–2470PubMedCrossRefGoogle Scholar
  29. 29.
    Ponziani FR, Zocco MA, Campanale C et al (2010) Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol 16:143–155PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Marco E. Allaix
    • 1
    Email author
  • Mukta K. Krane
    • 1
  • Marco Zoccali
    • 1
  • Konstantin Umanskiy
    • 1
  • Roger Hurst
    • 1
  • Alessandro Fichera
    • 2
  1. 1.Department of SurgeryUniversity of Chicago Medical CenterChicagoUSA
  2. 2.Department of SurgeryUniversity of Washington Medical CenterSeattleUSA

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