Portal vein thrombosis following laparoscopic sleeve gastrectomy: A rare case report

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy for morbid obesity

“…Initial treatment of a stable patient with non-occlusive thrombus consists of therapeutic anticoagulation with generally successful outcomes 3 5. However, as in the patient described in this case, severe occurrences of PVMT may require pharmacomechanical thrombectomy and transhepatic venous thrombolysis 2 5.…”

“…Additionally, hypercapnia as a result of the carbon dioxide insufflation will further cause inhibition of blood flow due to its vasoconstrictive action on the splanchnic and mesenteric region. Furthermore, several authors have noted that steep reverse Trendelenburg positioning may also cause additional stress to the patient's portal venous system, thus reducing blood flow and increasing portal pressure further 3 4 6 7. Distinctive from other gastric bypass procedures, LSG requires mechanical manipulation of the surrounding short gastric vessels of the stomach, as well as the left gastroepiploic arcade during skeletonisation of the greater curvature 4 8 10.…”

“…Although the condition has been known to occur in the postoperative period after a laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric banding procedures, PMVT has been noted with increased incidence in patients recovering from laparoscopic sleeve gastrectomy (LSG) 2. PMVT is rooted within multiple aetiologies, local and systemic 3. Patients who elect to undergo bariatric surgery, generally those who fall under the category of morbid obesity (MO) are more likely to be predisposed to metabolic syndrome, to begin with 4.…”

“…Certain laparoscopic operations still report thrombotic events with regularity: appendectomy, cholecystectomy and colectomy, as well as Nissen fundoplication and LSG for MO. The cause of PMVT in these cases has yet to be confirmed, but recent analysis of thrombotic events post-LSG indicate specific contributions which may catalyse their occurrence postoperatively: increased portal venous blood pressure and decreased blood flow due to pneumoperitoneum, mechanical and thermal effect on splenic vasculature and vessels of the greater curvature of the stomach, blood flow pattern alteration due to intraoperative ligation of the short gastric vessels, and restriction of liquid intake after surgery are all factors leading to thrombosis 1 3 4 6 7…”

Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

“…It is still uncertain what during laparoscopic procedures leads to the increased risk of thrombosis. It has been hypothesized that hemodynamic changes in pneumoperitoneum due to increased intra-abdominal pressure may play a role in thrombosis [ 19 ]. Furthermore, visceral vasoconstriction due to an increase of vasopressin intraoperatively, the retention of CO 2 causing increased portal pressure, and patient positioning during surgery may all also affect portal blood flow.…”