Surgical Endoscopy

, Volume 29, Issue 5, pp 1071–1079 | Cite as

Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors

  • Kristin A. Robinson
  • Mark E. O’Donnell
  • David Pearson
  • J. Scott Kriegshauser
  • Melanie Odeleye
  • Kristen Kalkbrenner
  • Zachary Bodnar
  • Tonia M. Young-Fadok
Article

Abstract

Background

Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery.

Methods

A single center retrospective review of patients undergoing colorectal surgery was performed (2007–2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors.

Results

There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn’s disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3 %) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53 % vs. 17 %, p < 0.01).

Conclusion

BMI ≥ 30 kg/m2, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4 %; however, after expert focused radiologic review, the actual rate was 3 %. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.

Keywords

Portomesenteric venous thrombosis Colorectal surgery Abdominal DVT Risk factors Inflammatory bowel disease 

References

  1. 1.
    Elliot JW (1895) II. The Operative Relief of Gangrene of Intestine Due to Occlusion of the Mesenteric Vessels. Ann Surg 21:9–23CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Singal AK, Kamath PS, Tefferi A (2013) Mesenteric venous thrombosis. Mayo Clin Proc 88:285–294CrossRefPubMedGoogle Scholar
  3. 3.
    Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby NH (2006) Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol 12:2115–2119PubMedCentralPubMedGoogle Scholar
  4. 4.
    del Rosario JF, Orenstein SR, Bhargava S, Putnam PE (1994) Thrombotic complications in pediatric inflammatory bowel disease. Clin Pediatr (Phila) 33:159–161CrossRefGoogle Scholar
  5. 5.
    Fichera A, Cicchiello LA, Mendelson DS, Greenstein AJ, Heimann TM (2003) Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 46:643–648CrossRefPubMedGoogle Scholar
  6. 6.
    Smalberg JH, Arends LR, Valla DC, Kiladjian JJ, Janssen HL, Leebeek FW (2012) Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis. Blood 120:4921–4928CrossRefPubMedGoogle Scholar
  7. 7.
    Valla D, Casadevall N, Huisse MG, Tulliez M, Grange JD, Muller O, Binda T, Varet B, Rueff B, Benhamou JP (1988) Etiology of portal vein thrombosis in adults. A prospective evaluation of primary myeloproliferative disorders. Gastroenterology 94:1063–1069PubMedGoogle Scholar
  8. 8.
    Abdu RA, Zakhour BJ, Dallis DJ (1987) Mesenteric venous thrombosis—1911 to 1984. Surgery 101:383–388PubMedGoogle Scholar
  9. 9.
    Abu-Daff S, Abu-Daff N, Al-Shahed M (2009) Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up. J Gastrointest Surg 13:1245–1250CrossRefPubMedGoogle Scholar
  10. 10.
    Brunaud L, Antunes L, Collinet-Adler S, Marchal F, Ayav A, Bresler L, Boissel P (2001) Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 34:673–679CrossRefPubMedGoogle Scholar
  11. 11.
    Harnik IG, Brandt LJ (2010) Mesenteric venous thrombosis. Vasc Med 15:407–418CrossRefPubMedGoogle Scholar
  12. 12.
    Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688CrossRefPubMedGoogle Scholar
  13. 13.
    Morasch MD, Ebaugh JL, Chiou AC, Matsumura JS, Pearce WH, Yao JS (2001) Mesenteric venous thrombosis: a changing clinical entity. J Vasc Surg 34:680–684CrossRefPubMedGoogle Scholar
  14. 14.
    Rhee RY, Gloviczki P, Mendonca CT, Petterson TM, Serry RD, Sarr MG, Johnson CM, Bower TC, Hallett JW Jr, Cherry KJ Jr (1994) Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 20:688–697CrossRefPubMedGoogle Scholar
  15. 15.
    Leebeek FW, Smalberg JH, Janssen HL (2012) Prothrombotic disorders in abdominal vein thrombosis. Neth J Med 70:400–405PubMedGoogle Scholar
  16. 16.
    Novacek G, Weltermann A, Sobala A, Tilg H, Petritsch W, Reinisch W, Mayer A, Haas T, Kaser A, Feichtenschlager T, Fuchssteiner H, Knoflach P, Vogelsang H, Miehsler W, Platzer R, Tillinger W, Jaritz B, Schmid A, Blaha B, Dejaco C, Eichinger S (2010) Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 139:779–787, 787 e771Google Scholar
  17. 17.
    Ottinger LW, Austen WG (1967) A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet 124:251–261PubMedGoogle Scholar
  18. 18.
    Kaleya RN (1989) Mesenteric venous thrombosis. In: Delaney JP, Najarian JS (eds) Progress in gastrointestinal surgery. Year Book Medical Publishers, Chicago, pp 417–425Google Scholar
  19. 19.
    Hansen HJ, Christoffersen JK (1976) Occlusive mesenteric infarction. A retrospective study of 83 cases. Acta Chir Scand Suppl 472:103–108PubMedGoogle Scholar
  20. 20.
    James AW, Rabl C, Westphalen AC, Fogarty PF, Posselt AM, Campos GM (2009) Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review. Arch Surg 144:520–526CrossRefPubMedGoogle Scholar
  21. 21.
    Ayala R, Grande S, Bustelos R, Ribera C, Garcia-Sesma A, Jimenez C, Moreno E, Martinez-Lopez J (2012) Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients. BMC Gastroenterol 12:114CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Ibele AR, Kennedy GD, Lund DP, Nichol PF (2010) Portal vein thrombus after pediatric proctocolectomy with ileoanal anastomosis. J Pediatr Surg 45:1026–1029CrossRefPubMedGoogle Scholar
  23. 23.
    Krauth MT, Lechner K, Neugebauer EA, Pabinger I (2008) The postoperative splenic/portal vein thrombosis after splenectomy and its prevention–an unresolved issue. Haematologica 93:1227–1232CrossRefPubMedGoogle Scholar
  24. 24.
    Allaix ME, Krane MK, Zoccali M, Umanskiy K, Hurst R, Fichera A (2014) Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections. World J Surg 38:976–984CrossRefPubMedGoogle Scholar
  25. 25.
    Ishizaki Y, Bandai Y, Shimomura K, Abe H, Ohtomo Y, Idezuki Y (1993) Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc 7:420–423CrossRefPubMedGoogle Scholar
  26. 26.
    Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR (2012) Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST J 141:e419S–e494SCrossRefGoogle Scholar
  27. 27.
    Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D (2000) Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 32:466–470CrossRefPubMedGoogle Scholar
  28. 28.
    Acosta S, Alhadad A, Svensson P, Ekberg O (2008) Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 95:1245–1251CrossRefPubMedGoogle Scholar
  29. 29.
    Goitein D, Matter I, Raziel A, Keidar A, Hazzan D, Rimon U, Sakran N (2013) Portomesenteric thrombosis following laparoscopic bariatric surgery: incidence, patterns of clinical presentation, and etiology in a bariatric patient population. JAMA Surg 148:340–346CrossRefPubMedGoogle Scholar
  30. 30.
    Swartz DE, Felix EL (2004) Acute mesenteric venous thrombosis following laparoscopic Roux-en-Y gastric bypass. JSLS 8:165–169PubMedCentralPubMedGoogle Scholar
  31. 31.
    Allman-Farinelli MA (2011) Obesity and venous thrombosis: a review. Semin Thromb Hemost 37:903–907CrossRefPubMedGoogle Scholar
  32. 32.
    Amitrano L, Brancaccio V, Guardascione MA, Margaglione M, Iannaccone L, Dandrea G, Ames PR, Marmo R, Mosca S, Balzano A (2001) High prevalence of thrombophilic genotypes in patients with acute mesenteric vein thrombosis. Am J Gastroenterol 96:146–149CrossRefPubMedGoogle Scholar
  33. 33.
    Thatipelli MR, McBane RD, Hodge DO, Wysokinski WE (2010) Survival and recurrence in patients with splanchnic vein thromboses. Clin Gastroenterol Hepatol 8:200–205CrossRefPubMedGoogle Scholar
  34. 34.
    Kwaan MR, Vogler SA, Sun MY, Sirany AM, Melton GB, Madoff RD, Rothenberger DA (2013) Readmission after colorectal surgery is related to preoperative clinical conditions and major complications. Dis Colon Rectum 56:1087–1092CrossRefPubMedGoogle Scholar
  35. 35.
    Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, Manguso F, Margaglione M, Ames PR, Iannaccone L, Grandone E, Romano L, Balzano A (2007) Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 102:2464–2470CrossRefPubMedGoogle Scholar
  36. 36.
    Ageno W, Squizzato A, Togna A, Magistrali F, Mangini M, Fugazzola C, Dentali F (2012) Incidental diagnosis of a deep vein thrombosis in consecutive patients undergoing a computed tomography scan of the abdomen: a retrospective cohort study. J Thromb Haemost 10:158–160CrossRefPubMedGoogle Scholar
  37. 37.
    Ball CG, MacLean AR, Buie WD, Smith DF, Raber EL (2007) Portal vein thrombi after ileal pouch-anal anastomosis: its incidence and association with pouchitis. Surg Today 37:552–557CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kristin A. Robinson
    • 3
  • Mark E. O’Donnell
    • 2
  • David Pearson
    • 1
  • J. Scott Kriegshauser
    • 3
  • Melanie Odeleye
    • 1
  • Kristen Kalkbrenner
    • 1
  • Zachary Bodnar
    • 1
  • Tonia M. Young-Fadok
    • 1
  1. 1.Divisions of Colorectal SurgeryMayo ClinicPhoenixUSA
  2. 2.Vascular and Endovascular SurgeryMayo ClinicPhoenixUSA
  3. 3.Department of RadiologyMayo ClinicPhoenixUSA

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