大波 勇一, 石田 秀明, 長沼 裕子, 宇野 篤, 紺野 啓, 正宗 研

Yuichi OHNAMI, Hideaki Ishida, Hiroko NAGANUMA, Atsushi UNO, Kei KONNO, Osamu MASAMUNE

秋田大学第1内科

First Department of Internal Medicine, Akita University School of Medicine

キーワード : Cavernomatous transformation of the portal vein (CTPV), Color Doppler Sonography, Portal thrombus, Splenectomy

Nine post-splenectomized patients with portalvein thrombus are reported here. Portal hypertension existed in eight of these nine cases; and complete obstruction of the portal vein was observed in six; incomplete obstruction, in three. The portal thrombus appeared as a high-echo mass in eight cases and was situated around the main portal vein in all cases. Cavernomatous transformation of the portal vein existed in all six cases of complete obstruction of the portal vein and in one of three cases of incomplete obstruction. Portal venous collateral circulation existed in four of the six cases of complete obstruction of the portal vein and in two of the three cases of incomplete obstruction. Previously published studies indicate that portal thrombi developed in the splenic veins of post-splenectomized patients. Our results do not corroborate these findings and this disagreement would appear to be related to the much longer period after splenectomy, which averaged 12 years in the present study but only a few weeks in the earlier studies. Color Doppler sonography proved very useful in the observation of hemodynamic changes in the portal system and in determining extension of portal thrombi. It thus appears highly advisable to use color Doppler sonography to monitor patients after splenectomy.