Splenic vein thrombosis surgery

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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

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

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]

 
 
 
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

  1. 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.
  2. Valla D (2015). "Splanchnic Vein Thrombosis". Semin Thromb Hemost. 41 (5): 494–502. doi:10.1055/s-0035-1550439. PMID 26080307.
  3. 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.
  4. 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.
  5. 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.