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Case Reports
. 2021 Feb:79:424-427.
doi: 10.1016/j.ijscr.2021.01.086. Epub 2021 Jan 26.

Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report

Ozan Şen  1 , Simay Kara  2 , Ahmet Gökhan Türkçapar  3
Affiliations
Case Reports

Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report

Ozan Şen et al. Int J Surg Case Rep. 2021 Feb.

Abstract

İNTRODUCTION AND IMPORTANCE: Porta-mesenteric vein thrombosis (PMVT) is a rare but fatal complication in patients who are undergoing bariatric surgery. In this report, we present a rare case of a PMVT after laparoscopic sleeve gastrectomy (LSG).

Case presentation: A 52-year-old male patient with a body mass index of 42 kg/m2 was admitted to our clinic for morbid obesity. Standart LSG was performed with 5 trocar technique. 15 days after LSG, the patient admitted to the emergency department with complaints of abdominal pain, nausea and vomiting. The patient was dehydrated. His C-reactive protein level was 138 mg/L. Abdominal computerized tomography with contrast was performed and showed thickening of a part of small bowel wall in 10 cm length. Also, major trombosis were detected in the superior mesenteric vein branches and portal vein. The patient was hospitalized and 2 × 10,000 IU/1.0 mL high dosage low moleculer weight heparin (LMWH) therapy was initiated. The patient's clinical signs recovered rapidly following treatment.

Clinical discussion: İn LSG, if the gastroepiploic venous arcus, which runs along the greater curvatura, and has a direct connection to the portal circulation is damaged, a local thrombus may form and move towards the portal system over time. Dehydration is another significant predisposing factor for PMVT. Some patients may develop life-threatening intestinal ischemia. Abdominal tomography with contrast plays a major role in diagnosis.

Conclusion: PMVT should be considered as a serious complication after LSG in patients with abdominal pain. With early diagnosis and anticoagulant therapy, patients's clinical symptoms may improve quicly.

Keywords: Bariatric surgery; Complication; Laparoscopic sleeve gastrectomy; Porto-Mesenteric vein trombosis.

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Conflict of interest statement

Declaration of Competing Interest The authors report no declarations of interest.

Figures

Fig. 1
Fig. 1
Coronal and axial abdominal computerized tomography section. Single arrow: Thrombus in portal vein, Double arrow: small bowel wall thickening area.
Fig. 2
Fig. 2
Coronal abdominal computerized tomography section. Long arrow: Thrombus in superior mesenteric vein branchs, Short arrow: İscemic intestinal segment.
See this image and copyright information in PMC

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