Acute mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a literature review

Over the last decade, laparoscopic sleeve gastrectomy has become an increasingly popular surgical procedure for morbid obesity. Moreover, post-laparoscopic sleeve gastrectomy mesenteric venous thrombosis is very rarely reported. The presentation varies from mild non-speciﬁc abdominal symptoms to life threatening surgical emergency. Superior mesenteric vein thrombosis after bariatric surgery is a difficult diagnosis that needs a high index of suspicion. We report a case of thrombosis of the superior mesenteric vein, who presented as acute emergency to emergency room, shortly after sleeve gastrectomy. Patient underwent laparotomy and offered a resection of 60 cm of infarcted proximal jejunum with restoration of bowel continuity later. Patient subsequently recovered and followed several times in our outpatient and was free of symptoms.

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Superior Mesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e31828b7fdb ◽

2013 ◽

Vol 23 (4) ◽

pp. e162-e163 ◽

Cited By ~ 11

Author(s):

Lucas Pineda ◽

Mohammad Sarhan ◽

Leaque Ahmed

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Superior Mesenteric Vein ◽

Mesenteric Vein Thrombosis ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Superior Mesenteric Vein Thrombosis

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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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Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

The American Surgeon ◽

10.1177/000313480507101013 ◽

2005 ◽

Vol 71 (10) ◽

pp. 856-860 ◽

Cited By ~ 10

Author(s):

George A. Poultsides ◽

W. Cannon Lewis ◽

Robert Feld ◽

David L. Walters ◽

David A. Cherry ◽

...

Keyword(s):

Portal Vein ◽

Thrombolytic Therapy ◽

Venous Thrombosis ◽

Portal Vein Thrombosis ◽

Superior Mesenteric Vein ◽

Right Hemicolectomy ◽

Published Data ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Laparoscopic Assisted

Portal vein thrombosis is a rare but well-reported complication after laparoscopic surgery. We present a case of portomesenteric venous thrombosis that occurred 8 days after a laparoscopic-assisted right hemicolectomy. Systemic anticoagulation failed to improve symptoms. The early postoperative state precluded the use of transarterial thrombolytic therapy. Transjugular intra-hepatic catheter-directed infusion of urokinase into the superior mesenteric vein resulted in clearance of thrombus and resolution of symptoms. The published data on laparoscopy-induced splanchnic venous thrombosis and transjugular intrahepatic intramesenteric thrombolysis are discussed.

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Thrombolysis in Central Splanchnic Thrombosis

Journal of Intensive Care Medicine ◽

10.1177/088506669701200508 ◽

1997 ◽

Vol 12 (5) ◽

pp. 269-275

Author(s):

Hendrik E. Demey ◽

Guy Lambrecht ◽

Greta Moorkens ◽

Peter Michielsen ◽

Jef Van Den Ende ◽

...

Keyword(s):

Abdominal Pain ◽

Venous Thrombosis ◽

Lupus Anticoagulant ◽

Superior Mesenteric Vein ◽

Therapeutic Option ◽

Literature Survey ◽

High Dose ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Thrombolytic Drug

We present 4 patients treated with streptokinase for different forms of abdominal venous thrombosis. Two patients suffered from central splanchnic venous thrombosis (superior mesenteric vein and bilateral iliac veins in Patient A, portal and superior mesenteric veins in Patient B). Both patients' presenting complaint was abdominal pain. In both, a temporary infection-associated circulating lupus anticoagulant presumably caused this condition. Two other patients presented with isolated portal vein thrombosis without lupus anticoagulant. Thrombolysis with high dose streptokinase (9 MU over 6 hours) successfully reopened the veins involved in all 4 patients. A literature survey showed that thrombolysis is a therapeutic option for mesenteric vein thrombosis, but there was no consensus on which thrombolytic drug should be given or on method of administration.

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