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Case Reports
. 2024 Dec 13;16(12):e75668.
doi: 10.7759/cureus.75668. eCollection 2024 Dec.

Defecation-Induced Splenic Rupture in a Patient With Portal Vein Thrombosis After Sleeve Gastrectomy: Case Report and Literature Review

Samira Y Zeid  1 , Sara Kuzmanovska  1 , Ekin Su Gorgulu  1 , Hanifi Onalan  1 , Servet Karagul  1
Affiliations
Case Reports

Defecation-Induced Splenic Rupture in a Patient With Portal Vein Thrombosis After Sleeve Gastrectomy: Case Report and Literature Review

Samira Y Zeid et al. Cureus. .

Abstract

Sleeve gastrectomy is the most commonly performed bariatric surgery, with a relatively high safety profile. Splenic rupture following portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy is a rare life-threatening complication. A morbidly obese 38-year-old female patient presented with acute onset abdominal pain 13 days after a laparoscopic sleeve gastrectomy. Radiological studies revealed portal vein thrombosis (PVT) and splenic hematoma. On the second day of hospitalization, while under observation with stable vital signs, the patient developed sudden hypotension and tachycardia after defecation. Emergency diagnostic tests revealed a splenic rupture, and an emergency laparotomy and splenectomy were performed. The patient received low-molecular-weight heparin (LMWH) and was discharged uneventfully 10 days after surgery. Patients who develop PVT after bariatric surgery should be closely monitored due to the risk of splenic rupture, especially in situations that cause intra-abdominal pressure changes such as defecation.

Keywords: defecation; emergent splenectomy; portal vein thrombosis; sleeve gastrectomy; splenic rupture.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT image of the patient on day of admission. Arrow indicates enlarged spleen.
Figure 2
Figure 2. Splenic rupture with hemoperitoneum. The red arrow indicates intra-abdominal fluid due to bleeding, and the black arrow shows the ruptured spleen.
Figure 3
Figure 3. IImage of explanted spleen. The arrow indicates the margin of separation between the multiple splenic lacerations and the intact capsule.
See this image and copyright information in PMC

References

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