Portomesenteric and splenic vein thrombosis after laparoscopic sleeve gastrectomy

Abstract

Portomesenteric venous thrombosis (PVT) is a rare and life-threatening complication after laparoscopic bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most popular methods of bariatric surgical procedures. We aimed to present a 27-year-old male patient who presented with thrombosis in the portal vein, superior mesenteric vein, and splenic vein following LSG. Patient presented with widespread abdominal pain in the epigastric region, loss of appetite, and constipation at the postoperative 41 st day; in color Doppler ultrasonography and computerized tomography, thrombosis was detected in portal vein and branches, splenic vein, portal confluence level, and superior mesenteric vein. The patient was given antithrombotic therapy and discharged without symptoms. The incidence of portal vein thrombosis has steadily increased with the increased number of laparoscopic bariatric operations. It requires a high degree of clinical suspicion as it presents with nonspecific symptoms. PVT should be considered in cases with atypical abdominal pain after bariatric surgery.

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

“…Systemic anticoagulant therapy should be continued for at least 3-6 months after discharge (13,19,20). If there is any underlying thrombophilic disease, anticoagulant therapy is advised to be used lifelong (9,13,21). In the literature, partial and/or total recanalization is established in acute PMVT with anticoagulant treatment (14).…”

“…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).…”