Thrombosis of Portal Venous System after Laparoscopic Cholecystectomy in a Patient with Prothrombin Gene Mutation

Abstract

This analysis suggests that prothrombin gene mutation G20210A should be studied in the workup of intraabdominal venous thrombosis following laparoscopic surgery.

Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

“…Local causes are abdominal inflammatory conditions such as pancreatitis, inflammatory bowel disease, infection, and abdominal surgeries especially with handling of the portal and mesenteric veins such as splenectomy [ 2 ]. Systemic causes are prothrombotic states secondary to genetic coagulopathies like protein C and S deficiency, prothrombin gene mutation [ 3 ], antithrombin III deficiency, factor V Leiden mutation, and hyperhomocysteinemia or acquired causes like contraceptive use [ 4 ], recent pregnancy, antiphospholipid syndrome, myeloproliferative disorders, and paroxysmal nocturnal hemoglobinuria.…”

Severe Mesenteric Venous Thrombosis After Laparoscopic Cholecystectomy

“…Preventza et al 6 reported a case of PMT associated with an elevation of the immunoglobulin G anticardiolipin antibody. Gul et al 4 reported about a patient with a heterozygous form of factor II (prothrombin) G20210A mutation. An exotic case of dengue viral infection-associated PMT after LCE was described by Dan et al 1 Dengue viral infection may be responsible for the downregulation of thrombomodulin-thrombin-protein C complex formation reducing activated protein C, activating the link between coagulation-inflammation pathways or autoimmunity against endothelial cells, but the most probable correlation between infection and thrombosis was dehydration as a major risk factor of thrombosis.…”

“…2,7 It is widely accepted that increased intra-abdominal pressure due to pneumoperitoneum can trigger PMT. 4 Several experimental and clinical studies showed that hepatic microcirculation, portal venous blood flow, and renal blood flow are decreased with increasing intra-abdominal pressure. 6,10 -13 Increased intra-abdominal pressure leads to a decrease in mesenteric and portal venous blood flow via direct pressure-induced compression.…”

“…In 3 of the reported cases, intravenous heparin anticoagulation with later change to oral anticoagulants were used for treatment of PMT. 1,4,5 In 1 case, intravenous therapeutic anticoagulation and percutaneous aspiration thrombectomy was performed. 6 Our case represents the most severe case of a PMT after LCE.…”

Venous acute disturbance of mesenteric circulation: diagnosis and treatment

“…Системными причинами заболевания могут быть различные тромбофилические состояния и коагулопатии: дефицит протеинов S и C, генетические дефекты протромбина, лейденовская мутация, дефицит антитромбина III, гипергомоцистеинемия, мутация G20210 протромбина и мутация JAK2 V617F, а также различные системные предрасполагающие состояния (сепсис, беременность, использование оральных контрацептивов, миелопролиферативные заболевания) [13,20,28,34,40,41,70,84].…”