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1.
Surg Endosc ; 36(5): 3332-3339, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34331132

RESUMO

BACKGROUND: Minimally invasive splenectomy is now well established for a wide range of pathologies. Portal vein thrombosis (PVT) is increasingly being recognised as a complication of splenectomy. The aim was to determine the incidence and risk factors for PVT after laparoscopic splenectomy. METHODS: All cases of elective laparoscopic splenectomy performed from 1993 to 2020 were reviewed. Parameters recorded included demographics, diagnostic criterion and post-operative outcomes. Data were analysed using Minitab V18 with a p < 0.05 considered significant. RESULTS: 210 patients (103 female, 107 male) underwent laparoscopic splenectomy (14 to 85 years). A major proportion of cases were performed for ITP (n = 77, p = 0.012) followed by lymphoma (n = 28), indeterminate lesions (n = 21) and myelofibrosis (n = 19). Ten patients developed symptomatic portal vein thrombosis (4.8%). Patients presented most commonly with pain and fever and diagnosis was confirmed by computed tomography (CT) or ultrasonography (USS). There were 10 conversions (4.8%) to open and two postoperative deaths, one from PVT and one from pneumonia. The remaining nine patients were successfully treated with anticoagulation. Of 19 patients with myelofibrosis, six patients developed PVT (p = 0.0002). Patients who developed PVT had significantly greater specimen weights (1773 g vs 348 g, p < 0.001). Forty-three patients had a specimen weight of 1 kg or greater, and of these 9 developed portal vein thrombosis (21%), versus one with PVT of 155 with a specimen weight of less than 1 kg (p < 0.0001). Myelofibrosis (p = 0.0039), specimen weight (p < 0.001) and mean platelet count (p = 0.0049) were predictive of PVT. CONCLUSION: A high index of suspicion for this complication should be maintained and prompt treatment with anticoagulation. High-risk patients should be considered for prophylactic anticoagulation and routine imaging of the portal vein.


Assuntos
Laparoscopia , Mielofibrose Primária , Trombose Venosa , Anticoagulantes/uso terapêutico , Feminino , Humanos , Incidência , Laparoscopia/efeitos adversos , Masculino , Veia Porta , Mielofibrose Primária/complicações , Estudos Retrospectivos , Fatores de Risco , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia
3.
Heart Lung Circ ; 26(12): e115-e117, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28728923

RESUMO

A sinus of Valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired. Very rarely, they present with acute symptoms as a result of rupture into the cardiac chamber. If left untreated, they almost always result in deteriorating cardiac function. We report a patient presenting with acute right heart failure and hepatorenal syndrome requiring urgent surgery and double patch repair.


Assuntos
Aneurisma Aórtico/complicações , Ruptura Aórtica/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência Cardíaca/etiologia , Síndrome Hepatorrenal/etiologia , Seio Aórtico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/cirurgia , Ecocardiografia Doppler em Cores , Seguimentos , Insuficiência Cardíaca/diagnóstico , Síndrome Hepatorrenal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
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