Splenic vein thrombosis surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]Sunny Kumar MD [3]
Overview
Overview
Splenectomy is recommended for all patients with bleeding varices associated with isolated splenic vein thrombosis. Splenectomy eliminates venous collateral outflow and decompresses surrounding varices.
Surgery
Surgery
Splenectomy is recommended for all patients with bleeding varices associated with isolated splenic vein thrombosis. Splenectomy eliminates venous collateral outflow and decompresses surrounding varices.
Splenic arterial embolization:[1][2][3][4][5]
- Rarely studied, associated with splenic abscess, and is recommended for patients with high operative risk and patients with diffuse metastatic disease.
| Abdominal pain and systemic inflammation and/or Thrombophilic factor | |||||||||||||||||||
| Confirm PVTportal vein thrombosis with unenhanced or contrast CT after informing radiologist about suspicion of PVT | |||||||||||||||||||
| Screen for general and local cause | |||||||||||||||||||
| Start LMWH *Start antibiotic if septic thrombophlebitis *Treat accurate cause when identified | |||||||||||||||||||
| If *Presenting sever abdominal pain despite of adequate anti-coagulation *Organ failure *Rectal bleeding | |||||||||||||||||||
| Yes | No | ||||||||||||||||||
| Discuss urgent laparotomy with senior surgeon | Close monitoring *Anti-coagulation continued for 6 months | ||||||||||||||||||
References
References
- ↑ Bouvier A, Gout M, Audia S, Chalumeau C, Rat P, Deballon O (2017). “[Routine screening of splenic or portal vein thrombosis after splenectomy]”. Rev Med Interne (in French). 38 (1): 3–7. doi:10.1016/j.revmed.2016.08.003. PMID 27639911.
- ↑ Valla D (2015). “Splanchnic Vein Thrombosis”. Semin Thromb Hemost. 41 (5): 494–502. doi:10.1055/s-0035-1550439. PMID 26080307.
- ↑ Gouin B, Robert-Ebadi H, Casini A, Beauverd Y, Fontana P, Righini M; et al. (2017). “[Splanchnic vein thrombosis]”. Rev Med Suisse. 13 (586): 2138–2143. PMID 29211374.
- ↑ Riva N, Ageno W (2017). “Approach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis”. Vasc Med. 22 (6): 529–540. doi:10.1177/1358863X17734057. PMID 29202678.
- ↑ Riva N, Donadini MP, Dentali F, Squizzato A, Ageno W (2012). “Clinical approach to splanchnic vein thrombosis: risk factors and treatment”. Thromb Res. 130 Suppl 1: S1–3. doi:10.1016/j.thromres.2012.08.259. PMID 23026649.
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