2008 Annual Meeting Abstracts
Portal Venous Thrombi (PVT) Following Ileal Pouch-Anal Anastomosis (IPAA) for Ulcerative Colitis (UC): Is There a Need for Early Post-Operative Detection?
Kelly D. Gonzales, M.D., Avneesh Gupta, M.D., Jaroslaw Tkacz, M.D., Arthur F. Stucchi, Ph.D., Jorge Soto, M.D., Erwin Hirsch, M.D., James M. Becker, M.D..
Boston University Medical Center, Boston, MA, USA.
Objective: Given that portal and mesenteric venous thrombi can be a serious complication after IPAA, our aim was to determine the frequency of PVT in patients following IPAA by contrast enhanced computed tomography (CT) scanning.
Design: Retrospective review from June 2003 to January 2008.
Setting: Academic medical center
Intervention: Contrast enhanced CT scan of the abdomen and pelvis.
Main Outcome Measures: Thrombi identified on contrast enhanced CT distributed in one or more of the following vessels: main portal vein, intrahepatic portal vein branches, superior mesenteric vein and inferior mesenteric vein.
Results: Over 55 months, 85 patients (ages 14-72, 52% male) underwent IPAA for UC by a single surgeon of which 15 were performed laparoscopically (18%). Twenty-seven of the patients that underwent open (32%) and 6 that underwent laparoscopy (7%) subsequently received a contrast enhanced CT scan of the abdomen/pelvis for various presentations: abdominal pain (33%), fever (21%), follow up (15%), rectal pain (6%), nausea/vomiting (6%), and other (18%). Of the 27 open patients, 22 underwent CT scan within six weeks of surgery. Of the 20 patients (24%) identified with PVT, 15 were discovered within 6 weeks of surgery (18%) including all 6 patients who underwent laparoscopic IPAA.
Conclusions: Since PVT is a frequent finding following IPAA for UC, early screening and detection with an abdominal ultrasound performed at two and six week post-operative follow up appointments is recommended to prevent the long-term sequelae of this serious complication.