Our Summary

This study looked at the risks associated with a common surgery to remove the spleen, which is often done to treat a variety of blood diseases. One of the major complications after this surgery can be the formation of blood clots in the veins leading to the spleen and intestines, a condition known as porto-spleno-mesenteric venous thrombosis.

The researchers analyzed information about patients who underwent this procedure over a period of about six years. They specifically looked at the patients’ age, sex, and data from before, during, and after the surgery. They used a type of scan called a Doppler ultrasound to check for blood clots after surgery.

The study included 22 patients, and found that six of them developed this type of blood clot. Interestingly, only two of those patients actually experienced symptoms. The patients who did develop blood clots were treated with medication to thin the blood, which successfully resolved the problem.

The researchers found that three main factors were associated with an increased risk of developing a blood clot after spleen removal: the size of the spleen, having a particular type of blood disorder called a myeloproliferative disorder, and receiving blood transfusions during surgery.

The study concluded that routinely checking for blood clots after spleen removal surgery can help doctors diagnose and treat this complication early, even in patients who aren’t experiencing symptoms. The researchers also found that patients with enlarged spleens or myeloproliferative disorders are at a greater risk of developing this complication.

FAQs

  1. What is the main treatment for a wide range of haematological diseases?
  2. What are the risk factors associated with the development of porto-spleno-mesenteric venous thrombosis after elective splenectomy?
  3. How are patients diagnosed and treated for porto-spleno-mesenteric venous thrombosis after splenectomy?

Doctor’s Tip

A doctor might advise a patient who has undergone splenectomy to be aware of the potential risk of developing porto-spleno-mesenteric venous thrombosis. They may recommend regular screening for thrombosis, especially for patients with splenomegaly or myeloproliferative disorders. Additionally, patients may be advised to avoid unnecessary platelet and red blood cell transfusions during surgery to reduce the risk of thrombosis. Early detection and treatment of thrombosis can lead to successful resolution with anticoagulation therapy.

Suitable For

Patients who are typically recommended for splenectomy include those with hematological disorders such as immune thrombocytopenia, myeloproliferative disorders, hereditary spherocytosis, thalassemia, lymphoma, leukemia, and other malignancies. Additionally, patients with a larger spleen diameter, myeloproliferative disorders, and those who require intraoperative platelet and red blood cell transfusions may be at a higher risk for developing porto-spleno-mesenteric venous thrombosis after splenectomy. Screening for thrombosis postoperatively is important in identifying and treating this complication promptly, even in asymptomatic cases.

Timeline

Before splenectomy:

  • Patient is diagnosed with a haematological disorder that requires splenectomy.
  • Patient undergoes preoperative evaluation and preparation for the surgery.
  • Patient may receive blood transfusions or other treatments to optimize their health before the procedure.

During splenectomy:

  • Patient undergoes the surgical removal of their spleen.
  • Intraoperative transfusions of blood products may be required.

After splenectomy:

  • Patient undergoes postoperative monitoring and care.
  • Patient may undergo postoperative doppler ultrasound screening for thrombosis.
  • Risk factors for porto-spleno-mesenteric venous thrombosis are evaluated, including spleen diameter, underlying haematological disorder, and intraoperative transfusions.
  • Patients with risk factors are identified and treated promptly with anticoagulation therapy if thrombosis is detected.
  • Patients with splenomegaly and myeloproliferative disorders are at greater risk for developing porto-spleno-mesenteric venous thrombosis.

What to Ask Your Doctor

  1. What are the potential complications of splenectomy, specifically porto-spleno-mesenteric venous thrombosis?
  2. How will I be monitored for the development of postoperative thrombosis after my splenectomy?
  3. Are there any risk factors specific to my medical history that increase my likelihood of developing porto-spleno-mesenteric venous thrombosis?
  4. What symptoms should I watch for that may indicate the presence of postoperative thrombosis?
  5. What treatment options are available if I were to develop porto-spleno-mesenteric venous thrombosis after my splenectomy?
  6. Are there any preventative measures I can take to decrease my risk of developing this complication?
  7. How common is porto-spleno-mesenteric venous thrombosis after splenectomy, and what is the typical outcome for patients who develop this complication?
  8. Should I be concerned about my spleen size or any specific hematological disorders that may increase my risk of postoperative thrombosis?
  9. How quickly should I seek medical attention if I suspect I may have symptoms of porto-spleno-mesenteric venous thrombosis after my splenectomy?
  10. Are there any additional tests or screenings that should be performed to monitor for potential complications following my splenectomy?

Reference

Authors: Baldari L, Boni L, Giuliani B, Cassinotti E. Journal: Front Immunol. 2023 Oct 20;14:1216283. doi: 10.3389/fimmu.2023.1216283. eCollection 2023. PMID: 37928557