Splenic vein thrombosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Historical Perspective
Though thrombosis of the splenic vein is infrequently reported in the literature,1 , 2 it is common knowledge among surgeons that this condition may follow splenectomy. In fact, local thrombosis at the site of ligation of the splenic artery and vein with extension back to the first branching vessel is to be expected. This degree of involvement of the splenic vein, however, should be symptom less, but it is potentially important because of possible extension into the portal venous system and as a source of emboli to the liver.
Classification
There is no established system for the classification of splenic vein thrombosis
Pathophysiology
When thrombosis of the splenic vein occurs, collateral vessels develop to shunt blood around the occluded splenic vein. The two most common collateral pathways use the short gastric vessels. In the distal esophagus, portosystemic collaterals connect the short gastric veins into the azygous system. Splenoportal collaterals decompress the short gastric veins through both the coronary vein into the portal vein and via the gastroepiploic arcade into the superior mesenteric vein. In either case, the hypertensive short gastric veins cause increased pressure within the submucosal veins of the gastric fundus, resulting in varices.W
Causes
Common causes of splenic vein thrombosis are :
Pancreatitis, pancreatic pseudocyst, pancreatic carcinoma, lymphoma, adenopathy from metastatic cancer, iatrogenic causes: Splenectomy, partial gastrectomy, distal spleno renal shunt, Factor V leiden mutation, prothrombin G20210A mutation.
Differentiating Splenic vein thrombosis from Other Diseases
Splenic vein thrombosis must be differentiated from hepatic vein thrombosis, portal vein thrombosis, testicular cancer, hyperhomocystenemia and deep vein thrombosis