Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy

Salinas, José; Barros, Diego; Salgado, Napoleón; Viscido, Germán; Funke, Ricardo; Pérez, Gustavo; Pimentel, Fernando; Boza, Camilo

doi:10.1007/s00464-013-3055-8

Cited by 81 publications

(74 citation statements)

References 37 publications

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“…It is thought that the intraabdominal pressure from pneumoperitoneum during laparoscopy and the steep reverse Trendelenburg position that is necessary during gastric plication and other bariatric procedures reduces portal venous blood flow, creating a prothrombotic state. 2,3,5 This, in combination with the propensity of patients who are obese to suffer thrombosis, hypothetically leads to PVT. One also needs to consider air travel as a further risk factor when such patients have been abroad for surgery, as in this case report.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients present within 6 weeks of surgery, with severe, nonspecific abdominal pain and nausea. 2,3 Vital signs and laboratory tests are often within normal limits. 2,3 The imaging modality of choice is CT, which will demonstrate the thrombosis, as well as any intestinal ischaemia, which can occur with extension of thrombus into the superior mesenteric vein (SMV).…”

Section: Discussionmentioning

confidence: 99%

“…This includes endovascular treatment or surgery for intestinal infarction. 2,3 Stable patients without these signs must be commenced on therapeutic anticoagulation immediately. This is probably one of the few clinical conditions where the risk of thrombus propagation outweighs the risks of bleeding.…”

Section: 3mentioning

confidence: 99%

“…2,3 One study reported that 1% of its cohort developed PVT after sleeve gastrectomy. 3 In patients undergoing abdominal surgery in general, the aetiology is multifactorial and includes systemic factors such as obesity and malignancy; local factors include localised inflammation and manipulation of the portomesenteric venous system; for example, in splenectomy. 4 As such, PVT following laparoscopic bariatric surgery specifically is poorly understood.…”

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Portal vein thrombosis following laparoscopic gastric plication

Som

Rikabi

Chang

et al. 2017

annals

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Portal vein thrombosis (PVT) following laparoscopic surgery including Roux-en-Y bypass, sleeve gastrectomy and Nissen's fundoplication is a rare but recognised complication. Laparoscopic gastric plication in a new procedure that is popular in some parts of the world. We report a case of a patient suffering PVT as a complication of this surgery. KEYWORDSBariatric surgery -Portal vein thrombosis -Complication -Tourism -Gastric plication Case reportA 30-year-old female from the United Kingdom underwent laparoscopic gastric plication for obesity in Prague. She presented to an emergency department in London 10 days after the surgery with worsening abdominal pain. She complained of central abdominal pain associated with nausea that radiated to her chest and back. She had vomited once, on the first postoperative day in Prague. The patient stated that she underwent a contrast study while still in hospital in Prague and that the results of this had been normal.She had not opened her bowels or passed flatus for 2 days. Her past medical history was unremarkable. She was tachycardic on admission and examination of her abdomen revealed epigastric tenderness. Blood tests showed a C-reactive protein (CRP) of 72; full blood count, serum biochemistry and liver function test were all within normal limits.Computed tomography (CT) of her abdomen and pelvis demonstrated a splenic infarct of the superior pole secondary to splenic vein thrombosis and a thrombus within the portal confluence and thrombosis of the right portal vein (Figs 1 and 2).She was commenced on therapeutic low molecular weight heparin (LMWH). Her thrombophilia screen was negative. She remained as an inpatient for 1 week while her symptoms resolved and her CRP decreased to less than 5. She continued LMWH for 4 weeks before starting warfarin. DiscussionPVT is a rare but potentially life-threatening complication of laparoscopic surgery. It has been reported following routine day surgery such as cholecystectomy 1 and also laparoscopic bariatric surgery. 2,3 One study reported that 1% of its cohort developed PVT after sleeve gastrectomy. 3 In patients undergoing abdominal surgery in general, the aetiology is multifactorial and includes systemic factors such as obesity and malignancy; local factors include localised inflammation and manipulation of the portomesenteric venous system; for example, in splenectomy. 4 As such, PVT following laparoscopic bariatric surgery specifically is poorly understood. It is thought that the intraabdominal pressure from pneumoperitoneum during laparoscopy and the steep reverse Trendelenburg position that is necessary during gastric plication and other bariatric procedures reduces portal venous blood flow, creating a prothrombotic state. 2,3,5 This, in combination with the propensity of patients who are obese to suffer thrombosis, hypothetically leads to PVT. One also needs to consider air travel as a further risk factor when such patients have been abroad for surgery, as in this case report. This is the second report of the compli...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 3mentioning

confidence: 99%

mentioning

confidence: 99%

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Portal vein thrombosis following laparoscopic gastric plication

Som

Rikabi

Chang

et al. 2017

annals

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Portomesenteric vein thrombosis following laparoscopic sleeve gastrectomy in a Chinese patient

et al. 2017

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A 51-year-old morbidly obese Chinese man was scheduled for laparoscopic sleeve gastrectomy in October 2016. He had a body mass index of 34 kg/m 2 complicated by metabolic syndrome. He had no history of thromboembolism. Surgery was performed using a 5-port technique. A liver retractor was inserted under direct vision. The greater curvature was mobilised up to the angle of His and the gastric sleeve was created. The operation lasted 125 minutes. The patient was mobile on postoperative day 2 and was discharged on day 5.On day 6 postoperatively, he presented to the surgical ward with nausea, vomiting, and epigastric pain. No peritoneal signs were elicited during physical examination. White cell count had increased to 10.1 x 10 9 /L (reference range, 4-11 x 10 9 /L), and serum creatinine level to 248 µmol/L (reference range, 67-109 µmol/L). He was kept nil by mouth and prescribed broad-spectrum antibiotics. A computed tomographic (CT) scan of the abdomen and pelvis with intravenous contrast was performed on postoperative day 8. The portal vein was not opacified and a wedge-shaped hypoenhancing area was seen at subcapsular S4 of the liver. These were attributed by the radiologist to the timing of acquisition and perfusion artefacts. Ascites was also identified on the CT scan.His condition deteriorated and he was transferred to the intensive care unit on postoperative day 9. A repeat contrast-enhanced CT on the same day, arranged in view of his rapid deterioration and the presence of unexplained ascites, revealed extensive thrombosis of the superior mesenteric vein, splenic vein, portal trunk, and portal veins (Fig). A long segment of small bowel appeared ischaemic. Hypoenhancement in the liver and spleen was evident and likely related to impaired perfusion. Emergent laparotomy was performed immediately and revealed small bowel gangrene extending from the proximal jejunum to mid-ileum with mesenteric vein thrombosis. The distal ileum showed venous

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