Porto-mesenteric vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity: Case series and literature review

Abstract

HighlightsPorto-mesenteric vein thrombosis is rare and fatal complication after laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients.Most patients presented with vague abdominal symptoms, so the physician should has high index of suspicion to recommend CT abdomen.Early diagnosis is of paramount importance for better outcome.Prophylactic anticoagulant is essential after LSG to prevent PMVT.

Laparoskopik Sleeve Gastrektomi Sonrası Portomezenterik Venöz Tromboembolinin Non-Operatif Yönetimi ve Uzun Dönem Anti Koagülan Proflaksinin Önemi

“…Portomesenteric venous thrombosis (PMVT) is caused by partial or complete obstruction of the portal, splenic, and/ or mesenteric vein thrombosis (14). PMVT can be seen after any surgery involving the gastrointestinal tract and may lead to life-threatening conditions such as mesenteric ischemia, intestinal infarct, and liver failure (13).…”

“…Patients may present with abdominal pain, nausea, vomiting, fatigue, fever, and tachycardia (1). It is difficult to diagnose PMVT during the postoperative period due to its nonspecific symptoms; clinical suspicion is important in diagnosis and awareness of bariatric surgery complications makes it easier to diagnose and treat (7,8,(13)(14)(15)(16)21). Symptoms are usually observed on average between 12-15 days postoperatively (13).…”

“…Early diagnosis is essential to prevent ischemia and to begin anticoagulant therapy (9). Abdominal CT with contrast, Doppler ultrasonography, and abdominal angiography are effective in the diagnosis of PMVT (1,14). CT with contrast is the best non-invasive diagnostic technique of PMVT and other related pathologies (8,20).…”

“…After LSG, PMVT was first reported in 2009 in a thrombophilic patient by Berthet et al (20). The pathophysiologic relationship between PMVT and sleeve gastrectomy is still not known (14,15). Thermal injury due to surgical instruments with energy, prolonged liver retraction, intervention to the intraoperative splanchnic vascular region, venous stasis due to high intraabdominal pressure, hypercapnia, prolonged work during reverse Trendelenburg position, dehydration, hypovolemia, obesity, smoking, oral contraceptive use, hypercoagulopathy, recent surgical history are all risk factors during the postoperative period that increase the risk of developing PMVT (1,8,10,17).…”

Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base

“…Requires a high clinical suspicion. Vague presenting clinical features so healthcare professionals need to consider PMVT in the differential diagnosis [ 151 ]. Needs to be regularly/ consistently reported when it occurs post-BS and included with any other DVT events that occur post-BS a possible effect on reported VTE estimate if issue is resolved.…”