Portomesenteric and splenic vein thrombosis after laparoscopic sleeve gastrectomy

Portomesenteric thrombosis is an important but rarely reported complication following bariatric surgery. It has been suggested that the incidence of portal vein thrombosis is directly related to many risk factors inherent in the bariatric population as well as factors related to local and systemic effects of laparoscopic surgery. Possible aetiologies vary from systemic inherited hypercoagulable states to a direct inflammatory reaction of portosystemic vessels. Here we present a case report of a 47-year-old obese women who underwent a robotic sleeve gastrectomy with subsequent development of a main portal vein, complete right intrahepatic portal vein and splenic vein thrombosis ultimately found to have a compound mutation of the methylenetetrahydrofolate reductase C677T and A1298C alleles.

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Superior mesenteric venous thrombosis as a first manifestation of Antithrombin III deficiency in the postoperative course of laparoscopic sleeve gastrectomy: a case study of 2 patients from 1211 bariatric patients

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz306 ◽

2019 ◽

Vol 2019 (11) ◽

Author(s):

Vassilis G Giannakoulis ◽

Vasiliki Ntella ◽

Andreas Kiriakopoulos ◽

Maria Kostrova ◽

Evangelos Menenakos

Keyword(s):

Sleeve Gastrectomy ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Antithrombin Iii ◽

Splenic Vein ◽

Mesenteric Venous Thrombosis ◽

Vein Thrombosis ◽

Life Threatening ◽

Bariatric Patients ◽

Time Of Presentation

Abstract Superior mesenteric venous thrombosis (SMVT) following laparoscopic sleeve gastrectomy (LSG) is a rare, potentially life-threatening complication, which presents either isolated, or as a part of portal/mesenteric/splenic vein thrombosis. Distinction between them possibly confers an important clinical and prognostic value. Antithrombin III (ATIII) deficiency causes an hypercoagulable state which predisposes to SMVT. We report the clinical presentation and treatment of two patients among 1211 LSGs (incidence = 0.165%) that presented with isolated SMVT and ATIII deficiency in an Academic Bariatric Center. Both patients had an unremarkable past medical history; none was smoker or had a previously known thrombophillic condition/thrombotic episode. Mean time of presentation was 15.5 days after LSG. Despite aggressive resuscitative and anticoagulation measures, surgical intervention was deemed necessary. No mortalities were encountered. Coagulation tests revealed ATIII deficiency in both patients.

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Portomesenteric Venous Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Do Energy Systems Pose as Instigating Factor to This Infrequent Complication?

Clinical Medicine Insights Case Reports ◽

10.1177/1179547619843503 ◽

2019 ◽

Vol 12 ◽

pp. 117954761984350 ◽

Cited By ~ 1

Author(s):

Mohammed N Bani Hani ◽

Abdel Rahman A Al manasra ◽

Firas Obeidat ◽

Mamoon H Al-Omari ◽

Farah Bani Hani

Keyword(s):

Sleeve Gastrectomy ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Splenic Vein ◽

Energy Systems ◽

University Hospital ◽

Published Data ◽

Vein Thrombosis ◽

Portomesenteric Venous Thrombosis

Background: Portomesenteric venous thrombosis (PMVT), a rare complication after laparoscopic sleeve gastrectomy (LSG). Severe consequences are owed to a high risk of bowel ischemia. Our aim is to present a series of patients who developed PMVT after LSG, highlighting the potential role of the vessel sealer and divider as a risk factor. Methods: Medical records of seven patients who underwent LSG and developed PMVT from April 2010 to January 2019, at King Abdullah University Hospital and Jordan University Hospital, Jordan were reviewed. Our findings were studied, audited, and compared with published data. Results: A sum of 4900 patients underwent LSG, 7 (0.14%) developed PMVT. The mean age and body mass index (BMI) were 36.8 years and 45 kg/m2, respectively. Four were women. Epigastric pain radiating to the back was the presenting symptom at a median time of 9 days after surgery. Computed tomography (CT) of the abdomen confirmed the diagnosis. Five patients presented with a total portal vein thrombosis (PVT), one with splenic vein thrombosis and one with dual portal and mesenteric vein thrombosis. Conclusion: Portomesenteric venous thrombosis is a relatively uncommon complication following LSG. Early recognition is required to avoid catastrophic outcomes. The role of energy systems in the development of PMVT remains unknown and requires further elaboration.

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