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INTRODUCTION: Restorative proctocolectomy (RPC) with IPAA has become the procedure of choice for surgical management of UC. Although patients with UC have a three times greater risk of venous thrombotic events than the general population, those patients who have undergone RPC and IPAA are at an even higher risk for life-threatening venous prothrombotic events. PVT has been increasingly observed after IPAA and can be one of the more serious post-operative complications. PVT usually presents with a spectrum of clinical symptoms including abdominal pain, fever, and/or leukocytosis. The aim of this study was to determine the incidence of confirmed portal and mesenteric venous thrombi in UC patients following either laparoscopic (LAP-RPC) or open-RPC and IPAA and to characterize their clinical presentation.METHODS: Between 6/2003 and 1/2008, 85 consecutive UC patients who underwent laparoscopic or open RPC-IPAA by a single surgeon were retrospectively evaluated. Any patient who received an abdominal/pelvic contrast enhanced computed tomography (CT) scan postoperatively was included. The symptoms necessitating radiologic evaluation were recorded. CT images were reviewed by two radiologists for the presence of PVT using a 5-point scale system and the location, if present, in one or more of the portal vessels (main portal vein, intrahepatic portal vein branches, superior mesenteric vein and inferior mesenteric vein) was recorded.RESULTS: Eighty-five patients (ages 14-72, 52% male) underwent RPC-IPAA for UC of which 15 were LAP-RPC (18%). Twenty-seven patients that underwent open RPC-IPAA (32%) and six that underwent LAP-RPC (7%) subsequently underwent 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%). In the cohort of 15 patients who underwent LAP-RPC, all 6 patients (40%) who went on to have a CT scan were diagnosed with PVT. Of the 20 patients (24%) identified with PVT, 15 were discovered within 6 weeks of surgery (18%) including all 6 patients who underwent LAP-RPC. CONCLUSION(S): PVT appears to be a more frequent finding following LAP-RPC than open RPC for UC. Patients considering elective surgery should be counseled regarding this potential risk and for those still interested in LAP-RPC, a pre-operative hypercoagulable work-up should be considered. Post-operatively, early screening with a coagulation panel and abdominal imaging studies at two and six weeks is recommended for either surgical approach.