Superior Mesenteric and Portal Vein Thrombosis following Laparoscopic Nissen Fundoplication

Abstract

This case report describes superior mesenteric and portal vein thrombosis after laparoscopic Nissen fundoplication. As a thromboembolic prophylaxis, 2,500 IU of dalteparin was given preoperatively. After postoperative day 19, the patient experienced gradually increasing abdominal pain, mostly related to meals. Physical examination and laboratory tests were normal. CT scan revealed a portal and superior mesenteric vein thrombosis. Dalteparin and warfarin treatment was started, and symptoms relieved rapidly. In a control Doppler ultrasound 1 month after the onset of the treatment, a good flow in the portal and superior mesenteric vein was seen. Possible mechanisms are discussed.

Portal Vein Thrombosis in Pregnancy: Case Report and Review of the Literature

“…6,8 Prompt treatment could also prevent progression to portal hypertension with risk of variceal hemorrhage. 5,9,10 Furthermore, early treatment could result in complete lysis of the clot, as was observed in our patient. Resolution of clot could be as early as four days, but could take up to one month.…”

Portal Vein Thrombosis After Laparoscopic Sigmoid Colectomy for Diverticulitis

“…18 Doppler ultrasound 5,6 or CT scan 4 showed complete resolution of portal thrombosis after one month with anticoagulation in the three cases reported of PVT after laparoscopic surgery.…”

“…4,6 It has been suggested that the development of PVT requires a combination of several predisposing factors. 18 Valeri et al 5 reported a case of PVT after laparoscopic sple- nectomy in a patient with idiopathic thrombocytopenia and stated that the platelet increase, the blood stasis in the splenic vein, and the endothelial lesions secondary to splenectomy may all be contributing factors.…”

“…3 However, thrombosis of the portal vein (PVT) is not a common complication after laparoscopic surgery, and only three cases have been reported in the literature. [4][5][6] Of these, the only case after colectomy involved a right hemicolectomy, which may have involved direct trauma to the superior mesenteric vein during the procedure. 4 In this report, we describe a case of PVT that occurred after laparoscopic sigmoid colectomy in a patient with symptomatic, recurrent diverticulitis.…”

Mesenteric Venous Thrombosis Following Laparoscopic Antireflux Surgery

“…Pneumoperitoneum-associated mesenteric venous thrombosis has been reported after laparoscopic Nissen fundoplication [15][16][17] and laparoscopic hemicolectomy [18]. In two of the three reports of mesenteric venous thrombosis following laparoscopic Nissen fundoplication, the patients received dalteparin, 2500 U, 1 hr prior to the procedure.…”