Evaluation of portal venous system in post splenectomised beta-thalassemic children: A prospective study in a tertiary care hospital

Shirish Silwal; Dinesh Prasad Koirala; K M Didarul Islam; Sanjeev Kharel; Sita Thapa; Subita Neupane

doi:10.1016/j.amsu.2022.103565

Evaluation of portal venous system in post splenectomised beta-thalassemic children: A prospective study in a tertiary care hospital

Ann Med Surg (Lond). 2022 Apr 18:77:103565. doi: 10.1016/j.amsu.2022.103565. eCollection 2022 May.

Authors

Shirish Silwal¹, Dinesh Prasad Koirala², K M Didarul Islam³, Sanjeev Kharel⁴, Sita Thapa⁵, Subita Neupane⁶

Affiliations

¹ Department of Pediatric Surgery, Kanti Children's Hospital, Kathmandu, Nepal.
² Department of General Surgery, Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
³ Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh.
⁴ Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal.
⁵ Kathmandu Medical College, Kathmandu University, Kathmandu, Nepal.
⁶ Department of General Practice and Emergency Medicine, National Academy of Health Science, Kathmandu, Nepal.

Abstract

Background: Splenectomy is a palliative management technique in children with β-thalassemia. Portal thrombosis is the most dreaded complication after splenectomy that requires fast diagnosis, effective therapy, and good follow-up to prevent protal hypertension. Thus, there is the importance of constant evaluation of portal venous system through Color Doppler Ultrasound. This cohort study aimed to observe the changes in the portal venous system in post-splenectomised β-thalassemic children.

Material and methods: This is a prospective observational cohort study carried out on all the pediatric patients who have undergone splenectomy in Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh from 2017 to 2019 for β-thalassemia. The color doppler of the portal venous system was done within the 7th to 10th post-operative day and after 3 months. Outcomes like mean the caliber of the portal vein, mean velocity within the portal vein, and color Doppler findings like Portal Vein Thrombosis (PVT) and Pathological change in Mean Volume (PMV) were calculated and compared in two headings: pre-operative period and postoperative period (7-10 POD and 3 months) with the help of paired t-test.

Results: Twenty-Eight β-thalassemia patients with a mean age of 10.43 ± 3.91 years planned to undergo splenectomy were included in our study. The pre-operative mean caliber and mean velocity of the portal vein were not statistically significant when compared after the postoperative period (7-10 POD and 3 months). But, continuous changes in portal vein were seen that could lead to normalization or pathological changes.

Conclusion: There are physiological and pathological changes in portal vein following splenectomy that could lead to varied complications like portal vein thrombosis and portal hypertension. Color Doppler Ultrasound findings along with close follow-up help in minimizing the pathological changes and complications.

Keywords: Portal hypertension; Portal vein thrombosis; Portal venous system; Splenectomy; Thalassemia; β-Thalassemia.