Portal vein thrombosis after laparoscopic splenectomy for systemic mastocytosis: A case report and review of the literature

INTRODUCTION: Laparoscopic splenectomy has become the surgical procedure of choice for various diseases of the spleen. Portal vein thrombosis (PVT) after splenectomy occurs in 0.5% to 22% of patients. Symptoms are nonspecific and include fever, abdominal pain, and epigastric distress. Risk factors for PVT after splenectomy include underlying hematologic disorders, massive splenectomy, and other hypercoagulable states. METHODS: We describe a case of PVT in a woman who underwent laparoscopic splenectomy for symptomatic splenomegaly secondary to systemic mastocytosis. The patient was discharged from the hospital without anticoagulation and experienced nonspecific symptoms beginning 10 days postoperatively. Diagnosis of PVT was made by contrast-enhanced abdominal computed tomography. The patient had no underlying risk factors. Anticoagulation treatment facilitated recanalization of the portal vein and this was verified by Doppler ultrasound at follow-up. CONCLUSIONS: PVT after laparoscopic splenectomy is not uncommon. Signs and symptoms are vague and require a high index of suspicion for timely diagnosis. Anticoagulation is the treatment of choice and allows recanalization of the portal system in the majority of cases.