Portal Vein Thrombi After Restorative Proctocolectomy: Serious Complication Without Long-Term Sequelae

Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Catalonia, Spain
Diseases of the Colon & Rectum (Impact Factor: 3.75). 11/2007; 50(10):1540-4. DOI: 10.1007/s10350-007-0297-3
Source: PubMed


Portal vein thrombi have been observed after restorative proctocolectomy and ileal pouch-anal anastomosis, and present as a clinical spectrum of abdominal pain, fever, and leukocytosis. Anticoagulation treatment is usually associated with resolution of symptoms. However, the long-term consequences and effect on pouch function are not known. The purpose of this study was to analyze the long-term functional outcome of patients with confirmed portal vein thrombi after restorative proctocolectomy.
A retrospective study of all patients undergoing restorative proctocolectomy from January 1997 to 2000 was performed. A case-control study was designed that matched 37 patients with confirmed portal vein thrombi in this period with 133 patients without portal vein thrombi; the groups were compared with respect to pouch function and quality of life by using the Global Cleveland Clinic Quality of Life Questionnaire for pelvic pouch patients.
The mean follow-up was 4.73 (range, 4.21-7.28) years. The percentage of male patients was 58.8. The most common diagnosis was ulcerative colitis (62.4 percent). There were no significant differences between portal vein thrombi patients and controls with respect to pouch function (number of bowel movements, urgency, incontinence), episodes of pouchitis, or quality of life.
Portal vein thrombi can be a serious complication after restorative proctocolectomy that usually resolves with anticoagulation therapy. Long-term pouch function and quality of life are not affected.

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    • "It was concluded that although PVT can be a serious complication after restorative proctocolectomy, it usually resolves with timely and appropriate anticoagulation. More importantly, long-term pouch function and quality of life are not affected by this complication [5]. Ball et al. reviewed 112 patients who underwent IPAA for ulcerative colitis and assessed the rate of PVT [6]. "
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    ABSTRACT: Postoperative portal vein thrombosis (PVT) is rare, but has been described after various open as well as minimal access abdominal operations, especially splenectomy and colorectal surgical procedures. We report the case of a 39-year-old female who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis with sigmoid cancer. She presented 14 days later with vague upper abdominal pain, nausea, vomiting and high output stoma. Doppler ultrasonography confirmed PVT and therefore anticoagulant therapy was started. Her condition improved dramatically and she underwent closure of ileostomy after finishing adjuvant chemotherapy. She remained well at 3-year follow-up with good pouch function and no local or distant recurrence. A high index of suspicion is essential for early diagnosis and prompt treatment of postoperative PVT after restorative proctocolectomy. Early anticoagulation is essential to avoid subsequent complications.
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    • "The majority of reported cases of mesenteric thrombosis in association with UC have been arterial, although venous thromboembolism has also been described.1427 Mesenteric, splenic and portal vein thrombosis were predominantly encountered as postsurgical complications.56121735 In our patient with UC, three rare thromboembolic phenomena, including portal vein, inferior mesenteric vein and splenic vein, were observed without a history of surgery. "
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