Mesenteric ischaemia secondary to portomesenteric venous thrombosis, 2 weeks post laparoscopic sleeve gastrectomy in a cirrhotic patient

Abstract

Portal vein thrombosis (PVT) following sleeve gastrectomy is rare. There are limited documented cases within the literature. The presentation of PVT varies on a spectrum from mild non-specific abdominal symptoms to life endangering clinical emergencies. This is the case of a 58-year-old woman who presented to the surgical assessment unit with acute onset abdominal pain 2 weeks post laparoscopic sleeve gastrectomy for morbid obesity. The initial diagnosis was that of a gastric sleeve leak. The patient deteriorated clinically and underwent a CT scan of her abdomen. This revealed the presence of an acute thrombus filling the portal vein with extension into the superior mesenteric vein branches. There were radiological changes suggestive of acute small bowel ischaemia. The patient underwent a laparotomy in theatre and 50 cm of the necrotic small bowel was resected. Postoperative care was carried out in the intensive care unit for 15 days.

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy in patient with liver cirrhosis

“…The prevalence of PMVT ranges from 1% in early stages of LC, to 30% in candidates for liver transplantation . In the past, cases have been reported in which PMVT developed after LSG in patients with LC . The occurrence of PMVT in LC patients has been linked to thrombophilic factors and reduced portal flow velocity .…”