Splenic vein thrombosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Historical Perspective
Though thrombosis of the splenic vein is infrequently reported in the literature,1 , 2 it is common knowledge among surgeons that this condition may follow splenectomy. In fact, local thrombosis at the site of ligation of the splenic artery and vein with extension back to the first branching vessel is to be expected. This degree of involvement of the splenic vein, however, should be symptom less, but it is potentially important because of possible extension into the portal venous system and as a source of emboli to the liver.
Classification
There is no established system for the classification of splenic vein thrombosis
Pathophysiology
When thrombosis of the splenic vein occurs, collateral vessels develop to shunt blood around the occluded splenic vein. The two most common collateral pathways use the short gastric vessels. In the distal esophagus, portosystemic collaterals connect the short gastric veins into the azygous system. Splenoportal collaterals decompress the short gastric veins through both the coronary vein into the portal vein and via the gastroepiploic arcade into the superior mesenteric vein. In either case, the hypertensive short gastric veins cause increased pressure within the submucosal veins of the gastric fundus, resulting in varices.W
Causes
Common causes of splenic vein thrombosis are :
Pancreatitis, pancreatic pseudocyst, pancreatic carcinoma, lymphoma, adenopathy from metastatic cancer, iatrogenic causes: Splenectomy, partial gastrectomy, distal spleno renal shunt, Factor V leiden mutation, prothrombin G20210A mutation.
Differentiating Splenic vein thrombosis from Other Diseases
Splenic vein thrombosis must be differentiated from hepatic vein thrombosis, portal vein thrombosis, testicular cancer, hyperhomocystenemia and deep vein thrombosis
Epidemiology and Demographics
The incidence of Splenic vein thrombosis was estimated to be 141,00 cases per 100,000 individuals worldwide. Splenic vein thrombosis affects men and women equally. There is no racial predilection for splenic vein thrombosis.
Risk Factors
Common risk factors in the development of splenic vein thrombosis include: Abdominal cancer, liver cirrhosis, surgery, thrombophilias, hormonal treatments, myeloproliferative disorders, sickle cell anemia
Screening
There is insufficient evidence to recommend routine screening for splenic vein thrombosis. However, routine screening of PSVT after elective splenectomy is warranted because it allows to start anticoagulant therapy and avoid further life-threatening complications. The incidence of PSVT is particularly high among patients operated on for lymphoma or with splenomegaly
Natural History, Complications, and Prognosis
- If left untreated, patients with splenic vein thrombosis may progress to develop sinistral portal hypertension, gastric varices, ascites, splenomegaly, atraumatic splenic rupture
Diagnosis
Diagnostic study of choice
Venous phase angiography accurately visualises both the location of splenic vein obstruction and the routes of collateralization.The diagnosis of splenic vein thrombosis is confirmed on angiography when selective injection of the splenic artery shows nonvisualization of the splenic vein on delayed images.
History and Symptoms
ost patients are asymptomatic SVT should be suspected in a :
- A patient with a history of pancreatitis and GI blood loss
- A patient with splenomegaly in the absence of portal hypertension, cirrhosis, and hematologic disease
- In the setting of isolated gastric varices
Other signs /symptoms:
- Splenomegaly with rare leukopenia, thrombocytopenia, splenic pain
- Abdominal pain