Top

Journal of Gastrointestinal Surgery

Published in:

01-03-2010 | Review Article

Management of Acute Post-operative Portal Venous Thrombosis

Authors: Ryan M. Thomas, Syed A. Ahmad

Published in: Journal of Gastrointestinal Surgery | Issue 3/2010

Abstract

Background

Portal vein thrombosis can be a devastating, but often overlooked, complication of hepatobiliary procedures. Symptoms of acute portal vein thrombosis range from nondescript abdominal pain to septic shock secondary to mesenteric ischemia.

Discussion

The surgeon must be cognizant of these symptoms and the potential for portal vein thrombosis after any hepatobiliary procedures as an expedient diagnosis and treatment is necessary in order to prevent thrombus propagation, bowel ischemia, and death. This report outlines the symptoms, diagnosis, and a review of the literature on the treatment of acute portal vein thrombosis after hepatobiliary surgery with a special note made regarding a case of portal vein thrombosis after pancreatectomy and autologous islet cell transplantation.

Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, Rosendaal FR, van Hoek B. Extrahepatic portal vein thrombosis: aetiology and determinants of survival. Gut 2001;49(5):720–724.CrossRefPubMed

Garcia-Pagan JC, Hernandez-Guerra M, Bosch J. Extrahepatic portal vein thrombosis. Semin Liver Dis 2008;28(3):282–292.CrossRefPubMed

Murad SD, Valla DC, de Groen PC, Zeitoun G, Haagsma EB, Kuipers EJ, Janssen HLA. Pathogenesis and treatment of Budd–Chiari syndrome combined with portal vein thrombosis. Am J Gastroenterol 2006;101(1):83–90.CrossRef

Sobhonslidsuk A, Reddy KR. Portal vein thrombosis: a concise review. Am J Gastroenterol 2002;97(3):535–541.CrossRefPubMed

Woo DH, Laberge JM, Gordon RL, Wilson MW, Kerlan RK Jr. Management of portal venous complications after liver transplantation. Tech Vasc Interv Radiol 2007;10(3):233–239.CrossRefPubMed

Wozney P, Zajko AB, Bron KM, Point S, Starzl TE. Vascular complications after liver transplantation: a 5-year experience. AJR Am J Roentgenol 1986;147(4):657–663.PubMed

Smoot RL, Christein JD, Farnell MB. Durability of portal venous reconstruction following resection during pancreaticoduodenectomy. J Gastrointest Surg 2006;10(10):1371–1375.CrossRefPubMed

Cohen J, Edelman RR, Chopra S. Portal vein thrombosis: a review. Am J Med 1992;92(2):173–182.CrossRefPubMed

Witte CL, Brewer ML, Witte MH, Pond GB. Protean manifestations of pylethrombosis. A review of thirty-four patients. Ann Surg 1985;202(2):191–202.CrossRefPubMed

10.

Sarin SK, Sollano JD, Chawla YK, Amarapurkar D, Hamid S, Hashizume M, Jafri W, Kumar A, Kudo M, Lesmana LA, Sharma BC, Shiha G, de Silva HJ, Members of the APASL Working Party on Portal Hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006;26(5):512–519.CrossRefPubMed

11.

Klempnauer J, Grothues F, Bektas H, Pichlmayr R. Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis. Br J Surg 1997;84(1):129–132.CrossRefPubMed

12.

Tessler FN, Gehring BJ, Gomes AS, Perrella RR, Ragavendra RR, Busuttil RW, Grant EG. Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol 1991;157(2):293–296.PubMed

13.

Bach AM, Hann LE, Brown KT, Getrajdman GI, Herman SK, Fong Y, Blumgart LH. Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 1996;201(1):149–154.PubMed

14.

Turnes J, Garcia-Pagan JC, Gonzalez M, Aracil C, Calleja JL, Ripoll C, Abraldes JG, Bañares R, Villanueva C, Albillos A, Ayuso JR, Gilabert R, Bosch J. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008;6(12):1412–1417.CrossRefPubMed

15.

Plessier A, Murad SD, Hernandez-Guerra M, Consigny Y, Fabris F, Heller J, Morard I, Langlet P, Bahr M, Eapen E, Miranda H, Deninger M, Vidaud D, Condat B, Hadengue A, Elias E, Primignani M, Garcia-Pagan JC, Janssen HL, Valla D. 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 2007;46(Supplement 1):310A.

16.

Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000;32(3):466–470.CrossRefPubMed

17.

Sheen CL, Lamparelli H, Milne A, Green I, Ramage JK. Clinical features, diagnosis and outcome of acute portal vein thrombosis. Q J Med 2000;93:531–534.

18.

Baril N, Wren S, Radin R, Ralls P, Stain S. The role of anticoagulation in pylephlebitis. Am J Surg 1996;172(5):449–453, discussion 452–3.CrossRefPubMed

19.

Lagasse JP, Bahallah ML, Salem N, Debillon G, Labarrière D, Serve MP, Advenier V, Causse X, Legoux JL. Acute thrombosis of the portal system. Treatment with alteplase and heparin or with heparin alone in 10 patients. Gastroenterol Clin Biol 1997;21(12):919–923.PubMed

20.

Rahmouni A, Mathieu D, Golli M, Douek P, Anglade MC, Caillet H, Vasile N. Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 1992;17(2):135–140.CrossRefPubMed

21.

Malkowski P, Pawlak J, Michalowicz B, Szczerban J, Wroblewski T, Leowska E, Krawczyk M. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003;50(54):2098–2100.PubMed

22.

Ludwig DJ, Hauptmann E, Rosoff L Jr, Neuzil D. Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery. J Vasc Surg 1999;30(3):551–554.CrossRefPubMed

23.

Poplausky MR, Kaufman JA, Geller SC, Waltman AC. Mesenteric venous thrombosis treated with urokinase via the superior mesenteric artery. Gastroenterology 1996;110(5):1633–1635.CrossRefPubMed

24.

Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005;16(5):651–661.PubMed

25.

Mergenthaler FW, Harris MN. Superior mesenteric vein thrombosis complicating pancreatoduodenectomy: successful treatment by thrombectomy. Ann Surg 1968;167(1):106–111.CrossRefPubMed

26.

Zyromski NJ, Howard TJ. Acute superior mesenteric-portal vein thrombosis after pancreaticoduodenectomy: treatment by operative thrombectomy. Surgery 2008;143(4):566–567.CrossRefPubMed

27.

Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation 2000;69(9):1772–1774.CrossRefPubMed

28.

Manzanet G, Sanjuan F, Orbis P, López R, Moya A, Juan M, Vila J, Asensi J, Sendra P, Ruíz J, Prieto M, Mir J. Liver transplantation in patients with portal vein thrombosis. Liver Transpl 2001;7(2):125–131.CrossRefPubMed

29.

Lerut JP, Mazza D, van Leeuw V, Laterre PF, Donataccio M, de Ville de Goyet J, Van Beers B, Bourlier P, Goffette P, Puttemans T, Otte JB. Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients. Transpl Int 1997;10(2):125–132.CrossRefPubMed

30.

Davidson BR, Gibson M, Dick R, Burroughs A, Rolles K. Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation. Transplantation 1994;57(8):1174–1177.CrossRefPubMed

31.

Stieber AC, Zetti G, Todo S, Tzakis AG, Fung JJ, Marino I, Casavilla A, Selby RR, Starzl TE. The spectrum of portal vein thrombosis in liver transplantation. Ann Surg 1991;213(3):199–206.CrossRefPubMed

32.

Kyoden Y, Tamura S, Sugawara Y, Matsui Y, Togashi J, Kaneko J, Kokudo N, Makuuchi M. Portal vein complications after adult-to-adult living donor liver transplantation. Transpl Int 2008;21(12):1136–1144.CrossRefPubMed

33.

Adani GL, Baccarani U, Risaliti A, Sponza M, Gasparini D, Bresadola F, de Anna D, Bresadola V. Percutaneous transhepatic portography for the treatment of early portal vein thrombosis after surgery. Cardiovasc Intervent Radiol 2007;30(6):1222–1226.CrossRefPubMed

34.

Stambo GW, Grauer L. Transhepatic portal venous power-pulse spray rheolytic thrombectomy for acute portal vein thrombosis after CT-guided pancreas biopsy. AJR Am J Roentgenol 2005;184(3 Suppl):S118–S119.PubMed

35.

Wahoff DC, Papalois BE, Najarian JS, Kendall DM, Farney AC, Leone JP, Jessurun J, Dunn DL, Robertson RP, Sutherland DE. Autologous islet transplantation to prevent diabetes after pancreatic resection. Ann Surg 1995;222(4):562–579, discussion 575–579.PubMed

36.

White SA, Davies JE, Pollard C, Swift SM, Clayton HA, Sutton CD, Weymss-Holden S, Musto PP, Berry DP, Dennison AR. Pancreas resection and islet autotransplantation for end-stage chronic pancreatitis. Ann Surg 2001;233(3):423–431.CrossRefPubMed

37.

Argo JL, Contreras JL, Wesley MM, Christein JD. Pancreatic resection with islet cell autotransplant for the treatment of severe chronic pancreatitis. Am Surg 2008;74(6):530,6. discussion 536–537.

38.

Mehigan DG, Bell WR, Zuidema GD, Eggleston JC, Cameron JL. Disseminated intravascular coagulation and portal hypertension following pancreatic islet autotransplantation. Ann Surg 1980;191(3):287–293.CrossRefPubMed

39.

Mirkovitch V, Campiche M. Successful intrasplenic autotransplantation of pancreatic tissue in totally pancreatectomised dogs. Transplantation 1976;21(3):265–269.CrossRefPubMed

40.

Horaguchi A, Merrell RC. Preparation of viable islet cells from dogs by a new method. Diabetes 1981;30(5):455–458.CrossRefPubMed

41.

Ricordi C, Tzakis AG, Carroll PB, Zeng YJ, Rilo HL, Alejandro R, Shapiro A, Fung JJ, Demetris AJ, Mintz DH. Human islet isolation and allotransplantation in 22 consecutive cases. Transplantation 1992;53(2):407–414.CrossRefPubMed

42.

Demertzis S, Ringe B, Gulba D, Rosenthal H, Pichlmayr R. Treatment of portal vein thrombosis by thrombectomy and regional thrombolysis. Surgery 1994;115(3):389–393.PubMed

43.

Dutta AK, Chacko A, George B, Joseph JA, Nair SC, Mathews V. Risk factors of thrombosis in abdominal veins. World J Gastroenterol 2008;14(28):4518–4522.CrossRefPubMed

44.

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. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007;102(11):2464–2470.CrossRefPubMed

45.

Henao EA, Bohannon WT, Silva MB Jr. Treatment of portal venous thrombosis with selective superior mesenteric artery infusion of recombinant tissue plasminogen activator. J Vasc Surg 2003;38(6):1411–1415.CrossRefPubMed

46.

Ozkan U, Oguzkurt L, Tercan F, Tokmak N. Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 2006;12(2):105–107.PubMed

47.

Kaplan JL, Weintraub SL, Hunt JP, Gonzalez A, Lopera J, Brazzini A. Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric catheter. Am Surg 2004;70(7):600–604.PubMed

Title: Management of Acute Post-operative Portal Venous Thrombosis
Authors: Ryan M. Thomas
Syed A. Ahmad
Publication date: 01-03-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0967-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of Acute Post-operative Portal Venous Thrombosis

Abstract

Background

Discussion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Discussion

Please log in to get access to this content

Other articles of this Issue 3/2010

Colonic Gene Expression in Conventional and Germ-Free Mice with a Focus on the Butyrate Receptor GPR109A and the Butyrate Transporter SLC5A8

Delay in Diagnostic Workup and Treatment of Esophageal Cancer

Inverted Meckel’s Diverticulum with Ectopic Pancreatic Tissue as a Source of Severe Gastrointestinal Bleeding

Protective Effects of Early CD4+ T Cell Reduction in Hepatic Ischemia/Reperfusion Injury

Surgery for Small Bowel Perforation in an Asian Population: Predictors of Morbidity and Mortality

Non-functional Neuroendocrine Carcinoma of the Pancreas: Incidence, Tumor Biology, and Outcomes in 2,158 Patients