An 11-year-old undergoes a laparoscopic splenectomy for hereditary spherocytosis. She returns with complaints of fever and abdominal pain. A doppler ultrasound is obtained which shows the following finding.

 

 

[size=20px]The next best step in management of this patient is

 

a Transjugular catheterization with thrombolytic transhepatic mechanical thrombectomy

 

b Thrombectomy

 

c Surgical portosystemic shunt

 

d Initiation of anticoagulation[/size]

D

D

Correct answer

d Initiation of anticoagulation

 

Splenectomy in the pediatric age group is most commonly performed for hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and malignant hematologic disorders.

 

Portal vein thrombosis (PVT) is a rare but serious complication after splenectomy. It commonly presents with abdominal pain and fever within the first week after surgery. In children undergoing splenectomy for hematologic disorders, the incidence of PVT is estimated to be six percent. However, this may be overly estimated as a report of 141 consecutive children undergoing splenectomy in Finland reported no incidence of PVT. There is no difference in rates of PVT in patients undergoing open versus laparoscopic splenectomy.

 

After identification of a portal vein thrombosis. The initial step is immediate initiation of anticoagulation. Commonly with a heparin infusion or therapeutic low-molecular-weight heparin. Anticoagulation continues for a minimum of 6 months if not longer. Catheter based techniques of mechanical and pharmacologic thrombolysis have also been used after the initial initiation of anticoagulation, but require specialists comfortable with these interventional techniques. surgical interventions and shunting are less common.

Correct answer

d Initiation of anticoagulation

 

Splenectomy in the pediatric age group is most commonly performed for hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and malignant hematologic disorders.

 

Portal vein thrombosis (PVT) is a rare but serious complication after splenectomy. It commonly presents with abdominal pain and fever within the first week after surgery. In children undergoing splenectomy for hematologic disorders, the incidence of PVT is estimated to be six percent. However, this may be overly estimated as a report of 141 consecutive children undergoing splenectomy in Finland reported no incidence of PVT. There is no difference in rates of PVT in patients undergoing open versus laparoscopic splenectomy.

 

After identification of a portal vein thrombosis. The initial step is immediate initiation of anticoagulation. Commonly with a heparin infusion or therapeutic low-molecular-weight heparin. Anticoagulation continues for a minimum of 6 months if not longer. Catheter based techniques of mechanical and pharmacologic thrombolysis have also been used after the initial initiation of anticoagulation, but require specialists comfortable with these interventional techniques. surgical interventions and shunting are less common.