Portomesenteric Venous Thrombosis After Laparoscopic Surgery

Abstract

Portomesenteric venous thrombosis following laparoscopic surgery usually manifests as nonspecific abdominal pain. Computed tomography can readily provide the diagnosis and demonstrate the extent of the disease. Treatment should be individualized based on the extent of thrombosis and the presence of bowel ischemia but should include anticoagulation therapy. Venous stasis from increased intra-abdominal pressure, intraoperative manipulation of splanchnic vasculature, and systemic thrombophilic states likely converges to produce this potentially lethal condition.

Portomesenteric vein thrombosis after gastric surgery

“…This decrease in venous flow varies from 35 % to 84 %. Insufflation with carbon dioxide induces a more substantial decrease in venous flow than with other inert gases [2,3]. This study revealed no significant difference in the incidence of PMVT between laparoscopic and open surgeries in cases of EGC.…”

“…Prompt initiation of anticoagulation therapy is the current recommendation for the treatment of acute PMVT [2]. Previous studies recommended a 6-to 12-month period of anticoagulation therapy [2].…”

“…PMVT occurs after several surgeries, such as liver transplantation, splenectomy, portosystemic shunt surgery, and gastric surgeries, including bariatric surgery [1]. Such cases exhibit a wide spectrum of clinical manifestations, including as an incidental finding in asymptomatic patients, as nonspecific abdominal pain, and as life-threatening bowel infarction [2].…”

“…Several studies investigated PMVT after laparoscopic or laparoscopic bariatric surgery, because pneumoperitoneum during laparoscopic surgery may induce pressure on the portomesenteric vasculature, which leads to thrombus formation [2,3].…”

“…Pneumoperitoneum during laparoscopic surgery may induce venous stasis [1,3], which may be associated with prolonged operation time in a fixed position and obesity [4]. Perigastric vessel wall injury may be caused by a more aggressive dissection of lymph nodes during cancer surgery [2]. Advancedstage cancer, a history of deep vein thrombosis (DVT) [5], and a combination of hereditary defects of anticoagulation factors may all be associated with a hypercoagulable state [6].…”