Pulmonary vein thrombosis after lower lobectomy of the left lung

Pulmonary vein thrombosis is a known complication after lung transplantation but has rarely been reported after lobectomy or bilobectomy. We report the case of a left upper pulmonary vein thrombosis following an uneventful left lower lobectomy for bronchial carcinoma. Postoperative arterial blood gas values and chest radiographs were normal. On postoperative day 5, the patient became progressively dyspneic, developed hemoptysis and showed total opacification of the left lung without mediastinal shift on chest radiography. The patient remained dyspneic despite intravenous antibiotic therapy for suspected pneumonia and absence of obstruction at bronchoscopy. Diagnosis of left upper pulmonary vein thrombosis was finally made by contrast-enhanced multislice computed tomography followed by pulmonary angiography. Further clinical deterioration under conservative treatment forced us to remove the remnant left upper lobe that already showed gangrenous alterations. Pulmonary vein thrombosis following lobectomy or bilobectomy is very rare. Only 7 cases have been reported in the literature so far. Conservative treatment with antibiotics and anticoagulants may be successful but in case of clinical deterioration the affected lobe has to be resected. The mechanism of thrombosis remains unclear although intraoperative torsion and injury of vessels seem to be most likely since pulmonary vein thrombosis occurred in the operated hemithorax only.     

Deformation of the bladder due to collateral circulation caused by thrombosis of the left femoral vein

A thrombus in the lower extremities as well as in its collateral circulation in the pelvis are not unusual conditions; however, bladder deformation due to such collateral circulation has not previously been reported. A case is presented of bladder deformation to the right due to collateral circulation caused by a thrombus in the lower left extremity in a 51-year-old man.     

脾切除术后肠系膜静脉血栓形成

本文报告脾切除术后肠系膜静脉血栓形成８例。发生于术后１０天￣１１年。术前误诊７例。全组均行手术治疗，切除坏死肠管及其相应系膜。治愈３例，死亡５例。本病是脾切除后一种严重致死性并发症，一旦发生，诊治困难，死亡率极高，外科工程师对其应有足够的认识。本文对其发病机理、诊断、治疗和预防进行了详细讨论。     

Portal vein thrombosis after splenectomy

BACKGROUND: Portal vein thrombosis (PVT) has been described after splenectomy, but the factors associated with its development and the clinical outcomes are poorly characterized. METHODS: Case logs of four surgeons from 1996 to 2001 were retrospectively reviewed to identify cases of postsplenectomy PVT. RESULTS: Eight cases of PVT (8%) among 101 splenectomies were identified. Indications for splenectomy in patients with PVT were myeloproliferative disease (n = 4), hemolytic anemia (n = 3), and myelodysplastic disorder (n = 1). All patients had splenomegaly (mean 1698 g, range 360 to 3150 g). Among 10 patients with myeloproliferative disease (MP), 4 patients (40%) developed PVT, compared with 4 of 12 patients (25%) with hemolytic anemia. Three of 4 patients (75%) with MP disease and spleen weight greater than 3,000 g developed PVT. Five patients developed PVT despite receiving prophylactic subcutaneous heparin postoperatively. Presenting symptoms included anorexia in 7 (88%), abdominal pain in 6 (75%), and both elevated leukocyte and platelet counts in 8 patients (100%). All diagnoses were made by contrast-enhanced computed tomography scan, and anticoagulation was initiated immediately. One patient died of intraabdominal sepsis; the others are alive with no clinical sequelae at 38 months of follow-up. CONCLUSIONS: PVT is a relatively common complication of splenectomy in patients with splenomegaly. A high index of suspicion, early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation are key to a successful outcome.     

Incidence of deep vein thrombosis after varicose vein surgery

BACKGROUND: Varicose vein surgery is generally considered to have little risk of postoperative deep vein thrombosis (DVT). This prospective study examined the incidence of DVT in patients undergoing varicose vein surgery. METHODS: Lower leg veins were assessed before operation by duplex ultrasonography in 377 patients, and reassessed 2-4 weeks after surgery, and again at 6 and 12 months. Patients were instructed to contact a physician if symptoms consistent with DVT occurred before the scheduled follow-up appointment. Preoperative prophylaxis (a single dose of subcutaneous heparin) was left to the discretion of the vascular surgeon. RESULTS: DVT was detected in 20 (5.3 per cent) of the 377 patients. Of these, only eight were symptomatic and no patient developed symptoms consistent with pulmonary embolus. Eighteen of the 20 DVTs were confined to the calf veins. Subcutaneous heparin did not alter the outcome. No propagation of thrombus was observed and half of the DVTs had resolved without deep venous reflux at 1 year. CONCLUSION: The incidence of DVT following varicose vein surgery was higher than previously thought, but these DVTs had minimal short- or long-term clinical significance.     

脾切除术后门静脉血栓部分成因分析与预防

目的分析脾切除术后门静脉血栓(portal vein thrombosis,PVT)的成因,做好脾切除手术围手术期的管理,有效地预防严重并发症的发生。方法回顾武汉市第七医院2005~2015年的211例脾切除术后门静脉血栓的发生的临床资料,同时进行分析总结。结果 211例病人脾切除术后91例发生PVT(43.13%)。非血栓组和血栓组的脾脏大小分别为(112.54±23.77)mm~2和(149.69±55.94)mm~2、门静脉直径(11.23±2.46)胁和(16.34±2.79)mm、脾静脉直径(10.42±1.99)mm和(12.87±3.01)mm、门静脉血流(12.96±2.31)cm/s和(9.43±2.08)cm/s、是否合并肝硬化及血液疾病,两组比较差异均有统计学意义(P0.05)。结论脾切除手术前是否合并肝硬化血液病、脾脏的大小、门静脉及脾静脉直径、门静脉血流速度对于预测术后PVT的形成有指导作用,应做好早期的预防与治疗。     

Persistence of collateral circulation after correction of aortic coarctation

The persistence of collateral circulation was evaluated one year after the correction of experimental aortic coarctation (CoA) by assessing renal perfusion with the Xenon 133-washout method and measuring distal aortic blood pressure during cross-clamping of the thoracic aorta. CoA was created in 7 puppies at 2 months of age and was corrected after a follow-up with a venous patch when the dogs were 9 months old. Two of the dogs were lost during the corrective operation due to anaesthetic complications. Four sham-operated dogs served as controls. One year after correction of CoA, four of the dogs had a pressure gradient of less than 5 mmHg at the site of CoA and one a pressure gradient of 15 mmHg. In renal perfusion measurements a mean decrease of 49% and 96% was found in the study and control groups, respectively. Blood pressures in the distal aorta decreased 47% and 83%, respectively. Two dogs in the study group had a distal blood pressure under 50 mmHg and their renal perfusion decreased markedly. Collateral circulation decreased with time after a good anatomic correction of CoA, so that one year after correction of experimental CoA about one half of the initial collateral capacity remained. This suggests that in most reoperations performed at least one year after the primary corrections, temporal shunting or a left side bypass is necessary to ensure sufficient circulation in the distal organs.     

Deep vein thrombosis after aneurysm surgery

In a prospective study of 100 consecutive patients who underwent operations for intracranial aneurysms, the incidence of deep vein thrombosis (DVT) was 14%. The diagnosis was based on contrast venography, which was carried out in any patient who showed clinical symptoms and signs of DVT. In the presence of DVT the patient was placed on bed rest and intravenous plus peroral anticoagulation was begun. No complications thought to be related to anticoagulation were observed. A programme of postoperative prophylaxis is suggested for a selected group of aneurysm patients with a high risk for thromboembolic disease.     

Deep vein thrombosis after thoracotomy.

In a prospective study of 183 patients undergoing lateral thoracotomy the 125 I fibrinogen uptake test and perioperative heparin prophylaxis for deep-vein thrombosis were investigated. There was an incidence of deep vein thrombosis in 51% in untreated control patients. The heparin prophylaxis effectively reduced the incidence of deep venous thrombosis to 28% (P less than 0.005) without increasing postoperative blood loss. Unilateral thrombosis was found to be significantly more frequent in the leg opposite the side of the thoracotomy (P less than 0.005). The 125I fibrinogen test is essential in assessing methods of prophylaxis but is not recommended as a routine.     

Re-anastomosis of the anomalous segmental pulmonary vein during inferior bilobectomy

An anomalous pulmonary vein anatomy could represent a challenge for the thoracic surgeon. In these cases, the incidence of complications during lung surgery is increased, especially the need to perform a pneumonectomy due to a wrong section of the vascular elements. All attempts to reduce this risk must be undertaken, including techniques to restore normal venous drainage. We present a case of re-anastomosis of the posterior segmental vein of the right upper lobe draining into the lower pulmonary vein during a right lower bilobectomy for lung cancer.     

Functional effect of collateral circulation after dearterialization of the liver

The functional effect of the collateral circulation after hepatic dearterialization was investigated in dogs with end-to-side protacaval shunt after ligation of hepatic artery. The functional effect of collateral circulation was far less than that of the native hepatic artery even for one week after occlusion of the common hepatic artery. However the functional effect of the collateral blood flow suddenly rose to the level of that of native hepatic artery one week after ligation of common hepatic artery or two weeks after ligation of proper hepatic artery.     

Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy

A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.