Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: 3 Case Reports and a Literature Review

Abstract

Case seriesPatient: Male, 27 • Female, 46 • Male, 46Final Diagnosis: —Symptoms: Vague abdominal pain • severe nausea • vomiting • fever and diffuse abdominal tendernesMedication: —Clinical Procedure: —Specialty: —Objective:Rare co-existance of disease or pathologyBackground:Porto-mesenteric venous thrombosis (PMVT) is an infrequent but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery (sleeve gastrectomy). Herein, we describe the clinical presentation, management, and outcome of 3 rare cases of PMVT after laparoscopic sleeve gastrectomy (LSG), successfully treated at our center.Case Report:All patients developed PMVT post-LSG and presented with diffused abdominal pain, nausea, and vomiting. Computed tomography (CT) of the abdomen confirmed the diagnosis of portal vein thrombosis. Two patients were treated conservatively with anticoagulation and thrombolytic therapy and the third patient required operative intervention with bowel resection.Conclusions:PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option.

Portomesenteric vein thrombosis following laparoscopic sleeve gastrectomy in a Chinese patient

“…Nonetheless some cases may be fulminant as in our patient with mesenteric ischaemia and infarction. [1][2][3][4][5] The initial manifestation of PMVT can be subtle so early diagnosis requires a high index of suspicion. Patients usually present 7 to 14 days postoperatively with nausea, vomiting, abdominal pain, and fever.…”

“…Patients usually present 7 to 14 days postoperatively with nausea, vomiting, abdominal pain, and fever. 1,4,5 Physical examination is mostly unrevealing. Apart from leukocytosis and mild elevation of liver enzymes, most laboratory tests are normal.…”

“…The use of a reverse Trendelenburg position and carbon dioxide pneumoperitoneum may cause a decrease in portal blood flow leading to stasis. 1,4,5 The change in blood flow due to ligation of the short gastric vessels may promote the occurrence of PMVT.…”

Venous acute disturbance of mesenteric circulation: diagnosis and treatment

“…В структуре острого нарушения брыжеечного кровообращения доля венозной формы ишемии кишечника колеблется от 5 до 15% [49,61,70,82], при этом частота ее диагностики значительно возросла при внедрении КТ органов брюшной полости в современный хирургический диагностический алгоритм [70]. В.С.…”

“…Среди других местных причин развития тромбоза в венозной портомезентериальной системе выделяют воспалительные заболевания органов брюшной полости (колит, острый панкреатит, дивертикулит и ряд других) и забрюшинного пространства (хронический пиелонефрит), открытые и лапароскопические операции на брюшной полости, травмы органов брюшной полости [33,34,39,49,57,70,71]. Довольно редко острый аппендицит осложняется развитием тромбоза в системе воротной и брыжеечной вен [9,87].…”