Thrombosis of the Superior Mesenteric and Portal Veins after Splenectomy and/or Distal Splenorenal Shunts

During the past ten years, 180 patients with liver cirrhosis and hematologic disorders underwent splenectomy and distal splenorenal shunts, 56 of whom were evaluated by CT, ultrasonography (US) and/or angiography, postoperatively at Hiroshima University Hospital and Hiroshima Red Cross Hospital. Five patients were asymptomatic; thrombosis was observed in 10; and two died of liver failure. Three patients each complained of postprandial epigastralgia with diarrhea, fever, and general malaise.

Angiography was performed to evaluate the patency of the shuts; CT and US, to follow up the liver cirrhosis - not the portal vein thrombosis. Since thrombosis of the portal venous system occurs frequently during surgery, and since it causes marked changes in portal vein hemodynamics, the portal and superior mesenteric veins must be observed by US and CT for the early postoperative detection and treatment, to avoid major surgery.