We report a case of severe portal vein thrombosis after Hassab's operation.
A 23-year-old woman was admitted to our hospital because of a left upper quadrant abdominal mass. Abdominal CT scan and angiography revealed splenomegaly, esophagogastric varices and obstruction of the splenic vein. Upper gastrointestinal endoscopy showed esophagogastric varices. Esophagogastric varices caused by obstruction of the splenic vein was diagnosed preoperatively and Hassab's operation was performed. After the operation, high fever and general malaise persisted. Abdominal CT scan revealed severe thrombi of the superior mesenteric and portal vein on the 10th postoperative day. She immediately treated with anticoagulant and antiplatelet therapies. On the 17th postoperative day, CT scan showed that the thrombi of the superior mesenteric and the portal veins were reduced. On the 48th postoperative day when she was discharged from our hospital, the thrombi were remained but the blood flow improved in the portal vein by ultrasonography.
Portal vein thrombosis occurs in 4.4-17.3% of all cases after splenectomy. The disease requires appropriate therapies because it can cause complete obstruction of the portal vein and superior mesenteric artery, and can do hepatic impairment and intestinal necrosis. Accordingly the disease must be kept in mind after Hassab's operation, and anticoagulant and antiplatelet therapies should immediately be started, if the onset is once confirmed.