Trombosis venosa portal posesplenectomía por anemia hemolítica. Reporte de caso y revisión de la literatura

  • William Alexander Sarmiento Burbano Universidad Nacional de Colombia
  • William Otero Regino Universidad Nacional de Colombia
  • Julian Ernesto Parga Bermúdez Universidad Nacional de Colombia, Hospital Universitario Nacional
Palabras clave: Esplenectomía, trombosis venosa portal, anemia hemolítica, varices gástricas

Resumen

La trombosis venosa portal secundaria a esplenectomía es una patología frecuente. En pacientes llevados a este procedimiento por anemia hemolítica, varios factores de riesgo locales y sistémicos contribuyen a su presentación. Esta complicación es potencialmente mortal y ha existido gran discusión sobre las intervenciones adecuadas para su prevención y tratamiento. Frecuentemente se desconoce esta alteración. Se presenta un caso y se hace una revisión del tema.

Biografía del autor/a

William Alexander Sarmiento Burbano, Universidad Nacional de Colombia
Residente de Medicina Interna. Universidad Nacional de Colombia. Bogotá, Colombia
William Otero Regino, Universidad Nacional de Colombia
Profesor Titular de Medicina, Coordinador de Gastroenterología, Universidad Nacional de Colombia, Hospital Universitario Nacional, Gastroenterólogo, Clínica Fundadores. Bogotá, Colombia
Julian Ernesto Parga Bermúdez, Universidad Nacional de Colombia, Hospital Universitario Nacional
Internista, fellow de Gastroenterilogía, Universidad Nacional de Colombia, Hospital Universitario Nacional. Bogotá, Colombia

Citas

Targarona EM. Portal vein thrombosis after laparoscopic splenectomy: the size of the risk. Surg Innov. 2008;15(4):266-70. doi: 10.1177/1553350608324931.

Gelas T, Scalabre A, Hameury F, Dubois R, Grosos C, Mouriquand PD, et al. Portal vein thrombosis after laparoscopic splenectomy during childhood. J Thromb Thrombolysis. 2014;38(2):218-22. doi: 10.1007/s11239-013-1037-2.

Vecchio R, Cacciola E, Cacciola RR, Marchese S, Intagliata E. Portal vein thrombosis after laparoscopic and open splenectomy. J Laparoendosc Adv Surg Tech A. 2011;21(1):71-5. doi: 10.1089/lap.2010.0325.

Stamou KM, Toutouzas KG, Kekis PB, Nakos S, Gafou A, Manouras A, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg. 2006;141(7):663-9.doi: 10.1001/archsurg.141.7.663.

Rice HE, Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, et al. Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia registry. Am J Hematol. 2015;90(3):187-92. doi: 10.1002/ajh.23888.

Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg. 2008;95(10):1245-51. doi: 10.1002/bjs.6319.

Ponziani FR, Zocco MA, Garcovich M, D’Aversa F, Roccarina D, Gasbarrini A. What we should know about portal vein thrombosis in cirrhotic patients: a changing perspective. World J Gastroenterol. 2012;18(36):5014-20. doi: 10.3748/wjg.v18.i36.5014.

Li MX, Zhang XF, Liu ZW, Lv Y. Risk factors and clinical characteristics of portal vein thrombosis after splenectomy in patients with liver cirrhosis. Hepatobiliary Pancreat Dis Int. 2013;12(5):512-9.

de’Angelis N, Abdalla S, Lizzi V, Esposito F, Genova P, Roy L, et al. Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy. Surgery. 2017;162(6):1219-1230. doi: 10.1016/j.surg.2017.07.016.

Ushitora Y, Tashiro H, Takahashi S, Amano H, Oshita A, Kobayashi T, et al. Splenectomy in chronic hepatic disorders: portal vein thrombosis and improvement of liver function. Dig Surg. 2011;28(1):9-14. doi: 10.1159/000321886.

Wang M, Zhang M, Li J, Zhou J, Wu Z, Peng B. Risk factors of portal vein thrombosis in patients with beta thalassemia major after splenectomy: laparoscopic versus open procedure. Hepatogastroenterology. 2014;61(129):48-54.

Cheng J, Tao K, Yu P. Laparoscopic splenectomy is a better surgical approach for spleen-relevant disorders: a comprehensive meta-analysis based on 15-year literatures. Surg Endosc. 2016;30(10):4575-88. doi: 10.1007/s00464-016-4795-z.

Rottenstreich A, Kleinstern G, Spectre G, Da’as N, Ziv E, Kalish Y. Thromboembolic Events Following Splenectomy: Risk Factors, Prevention, Management and Outcomes. World J Surg. 2018;42(3):675-681. doi: 10.1007/s00268-017-4185-2.

Lee DH, Barmparas G, Fierro N, Sun BJ, Ashrafian S, Li T, et al. Splenectomy is associated with a higher risk for venous thromboembolism: A prospective cohort study. Int J Surg. 2015;24(Pt A):27-32. doi: 10.1016/j.ijsu.2015.10.011.

Pommerening MJ, Rahbar E, Minei K, Holcomb JB, Wade CE, Schreiber MA, et al. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism. Surgery. 2015;158(3):618-26. doi: 10.1016/j.surg.2015.06.014.

Pietrabissa A, Moretto C, Antonelli G, Morelli L, Marciano E, Mosca F. Thrombosis in the portal venous system after elective laparoscopic splenectomy. Surg Endosc. 2004;18(7):1140-3.doi: 10.1007/s00464-003-9284-5.

Borrazzo EC, Daly JM, Morrisey KP, Fischer E, Belmont M, Hogle NJ, et al. Hand-assisted laparoscopic splenectomy for giant spleens. Surg Endosc. 2003;17(6):918-20. doi: 10.1007/s00464-002-8946-z.

Ruiz-Tovar J, Priego P. Portal Vein Thrombosis After Splenic and Pancreatic Surgery. Adv Exp Med Biol. 2017;906:241-251. doi: 10.1007/5584_2016_119.

Condat B, Valla D. Nonmalignant portal vein thrombosis in adults. Nat Clin Pract Gastroenterol Hepatol. 2006;3(9):505-15. doi: 10.1038/ncpgasthep0577.

Ponziani FR, Zocco MA, Campanale C, Rinninella E, Tortora A, Di Maurizio L, et al. Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 2010;16(2):143-55.doi: 10.3748/wjg.v16.i2.143.

Lee HK, Park SJ, Yi BH, Yeon EK, Kim JH, Hong HS. Portal vein thrombosis: CT features. Abdom Imaging. 2008;33(1):72-9. doi: 10.1007/s00261-007-9200-x.

De Stefano V, Martinelli I. Splanchnic vein thrombosis: clinical presentation, risk factors and treatment. Intern Emerg Med. 2010;5(6):487-94. doi: 10.1007/s11739-010-0413-6.

Zhang N, Yao Y, Xue W, Wu S. Early prophylactic anticoagulation for portal vein system thrombosis after splenectomy: A systematic review and meta-analysis. Biomed Rep. 2016;5(4):483-490. doi: 10.3892/br.2016.755.

Wang H, Kopac D, Brisebois R, Sample C, Shapiro AM. Randomized controlled trial to investigate the impact of anticoagulation on the incidence of splenic or portal vein thrombosis after laparoscopic splenectomy. Can J Surg. 2011;54(4):227-31. doi: 10.1503/cjs.049909.

Qi X, Bai M, Guo X, Fan D. Pharmacologic prophylaxis of portal venous system thrombosis after splenectomy: a meta-analysis. Gastroenterol Res Pract. 2014;2014:292689. doi: 10.1155/2014/292689.

Qi X. Portal Vein Thrombosis: Recent Advance. Adv Exp Med Biol. 2017;906:229-39. doi: 10.1007/5584_2016_118.

Congly SE, Lee SS. Portal vein thrombosis: should anticoagulation be used? Curr Gastroenterol Rep. 2013;15(2):306. doi: 10.1007/s11894-012-0306-0.

Amitrano L, Guardascione MA, Menchise A, Martino R, Scaglione M, Giovine S, et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol. 2010;44(6):448-51. doi: 10.1097/MCG.0b013e3181b3ab44.

Smalberg JH, Spaander MV, Jie KS, Pattynama PM, van Buuren HR, van den Berg B, et al. Risks and benefits of transcatheter thrombolytic therapy in patients with splanchnic venous thrombosis. Thromb Haemost. 2008;100(6):1084-8.

Wang MQ, Guo LP, Lin HY, Liu FY, Duan F, Wang ZJ. Transradial approach for transcatheter selective superior mesenteric artery urokinase infusion therapy in patients with acute extensive portal and superior mesenteric vein thrombosis. Cardiovasc Intervent Radiol. 2010;33(1):80-9. doi: 10.1007/s00270-009-9777-2.

Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging. 2011;36(4):390-8. doi: 10.1007/s00261-010-9637-1.

De Santis A, Moscatelli R, Catalano C, Iannetti A, Gigliotti F, Cristofari F, et al. Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study. Dig Liver Dis. 2010;42(6):451-5. doi: 10.1016/j.dld.2009.08.009.

Qi X, Han G. Transjugular intrahepatic portosystemic shunt in the treatment of portal vein thrombosis: a critical review of literature. Hepatol Int. 2012;6(3):576-90. doi: 10.1007/s12072-011-9324-5.

Cao G, Ko GY, Sung KB, Yoon HK, Gwon DI, Kim JH. Treatment of postoperative main portal vein and superior mesenteric vein thrombosis with balloon angioplasty and/or stent placement. Acta Radiol. 2013;54(5):526-32. doi: 10.1177/0284185113475917.

Crawford JM. Vascular disorders of the liver. Clin Liver Dis. 2010;14(4):635-50. doi: 10.1016/j.cld.2010.08.002.

Silva-Junior G, Turon F, Hernandez-Gea V, Darnell A, García-Criado Á, García-Pagán JC. Unexpected disappearance of portal cavernoma on long-term anticoagulation. J Hepatol. 2014;61(2):446-8. doi: 10.1016/j.jhep.2014.04.002.

Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65(1):310-335. doi: 10.1002/hep.28906.

Abby Philips C, Sahney A. Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. Gastroenterol Rep (Oxf). 2016;4(3):186-95. doi: 10.1093/gastro/gow018.

Sarin SK, Kumar A. Endoscopic treatment of gastric varices. Clin Liver Dis. 2014;18(4):809-27. doi: 10.1016/j.cld.2014.07.004.

Lo GH. Endoscopic treatments for portal hypertension. Hepatol Int. 2018;12(Suppl 1):91-101. doi: 10.1007/s12072-017-9828-8.

Sharma BC, Banka AK, Rawat A, Srivastava S. Gastric Varices in Cirrhosis versus Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-Butyl-2-cyanoacrylate Injection. J Clin Exp Hepatol. 2013;3(1):19-23. doi: 10.1016/j.jceh.2013.01.002.

Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement. Medicine (Baltimore). 2015;94(41):e1725. doi: 10.1097/MD.0000000000001725.

Ríos Castellanos E, Seron P, Gisbert JP, Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev. 2015;(5):CD010180. doi: 10.1002/14651858.CD010180.pub2.

Binmoeller KF, Weilert F, Shah JN, Kim J. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos). Gastrointest Endosc. 2011;74(5):1019-25. doi: 10.1016/j.gie.2011.06.030.

Sugimoto N, Watanabe K, Watanabe K, Ogata S, Shimoda R, Sakata H, et al. Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate. J Gastroenterol. 2007;42(7):528-32.doi: 10.1007/s00535-007-2041-0.

Mishra SR, Sharma BC, Kumar A, Sarin SK. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol. 2011;54(6):1161-7. doi: 10.1016/j.jhep.2010.09.031.

McAvoy NC, Plevris JN, Hayes PC. Human thrombin for the treatment of gastric and ectopic varices. World J Gastroenterol. 2012;18(41):5912-7. doi: 10.3748/wjg.v18.i41.5912.

Min SK, Kim SG, Kim YS, Bae JY, Lee JC, Lee SH, et al. Comparison among endoscopic variceal obliteration, endoscopic band ligation, and balloon-occluded retrograde transvenous obliteration for treatment of gastric variceal bleeding. Korean J Gastroenterol. 2011 25;57(5):302-8.

Bai M, Qi XS, Yang ZP, Wu KC, Fan DM, Han GH. EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis: A meta-analysis. World J Gastrointest Pharmacol Ther. 2014;5(2):97-104. doi: 10.4292/wjgpt.v5.i2.97.

Shimamatsu K, Wanless IR. Role of ischemia in causing apoptosis, atrophy, and nodular hyperplasia in human liver. Hepatology. 1997;26(2):343-50. doi: 10.1002/hep.510260214.

Marin D, Galluzzo A, Plessier A, Brancatelli G, Valla D, Vilgrain V. Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Eur Radiol. 2011;21(10):2074-82. doi: 10.1007/s00330-011-2161-z.

Ibrahim M, Mostafa I, Devière J. New Developments in Managing Variceal Bleeding. Gastroenterology. 2018;154(7):1964-1969. doi: 10.1053/j.gastro.2018.02.023.

Publicado
2019-04-01
Cómo citar
Sarmiento Burbano, W. A., Otero Regino, W., & Parga Bermúdez, J. E. (2019). Trombosis venosa portal posesplenectomía por anemia hemolítica. Reporte de caso y revisión de la literatura. Revista Colombiana De Gastroenterología, 34(1), 91-96. https://doi.org/10.22516/25007440.358
Sección
Reporte de Casos