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Case Reports
. 2019 Nov 20;2019(11):rjz306.
doi: 10.1093/jscr/rjz306. eCollection 2019 Nov.

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

Vassilis G Giannakoulis  1 , Vasiliki Ntella  1 , Andreas Kiriakopoulos  1 , Maria Kostrova  1 , Evangelos Menenakos  1
Affiliations
Case Reports

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

Vassilis G Giannakoulis et al. J Surg Case Rep. .

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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Figures

Figure 1
Figure 1
Contrast-enhanced abdominal CT demonstrating SMV thrombosis. Black arrow indicates the thrombus inside the vein, whereas the dotted black arrows indicate gas within the small-bowel wall (pneumatosis intestinalis).
See this image and copyright information in PMC

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