Skip to main content

Advertisement

SpringerLink
Log in

Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature

  • Review Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Portomesenteric venous thrombosis (PMVT) is a rare and potentially life-threatening condition with high morbidity and mortality. Its incidence is low as complication of bariatric surgery and laparoscopic sleeve gastrectomy (LSG) and the reason is unclear and is likely multifactorial. Genetic predisposition, oral contraceptive, thrombophilia, intra-abdominal pressure due to pneumoperitoneum, reverse Trendelenburg position, prolonged operation time, DM, and obesity may be considered as risk factors. Extended low-molecular-weight heparin anticoagulation prophylaxis to prevent PMVT is a reasonable choice for patients after LSG; however, no clear guidelines about the optimal dose, duration, and type of heparin are currently available. In this study, we present a case of a 50-year-old woman who was admitted to the emergency department for abdominal pain 2 weeks after LSG. Her computed tomography scan showed a portomesenteric venous thrombosis. Our review of the English literature found only 137 morbidly obese patients who had developed PMVT after bariatric surgery between 2002 and July 2018, demonstrating rarity of this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Robbins MR, Comerota AJ, Pigott JP (2005) Mesenteric venous thrombosis. Vasc Med 10:121–122

    Article  Google Scholar 

  2. Goitein D, Matter I, Raziel A, Keidar A, Hazzan D, Rimon U, Sakran N (2013) Portomesenteric thrombosis following laparoscopic bariatric surgery: incidence, patterns of clinical presentation, and etiology in a bariatric patient population. JAMA Surg 148:340–346

    Article  Google Scholar 

  3. Shaheen O, Siejka J, Thatigotla B, Pham D (2017) A systematic review of portomesenteric vein thrombosis after sleeve gastrectomy. Surg Obes Relat Dis 13(8):1422–1431

    Article  Google Scholar 

  4. Rocha AT, de Vasconcellos AG, da Luz Neto ER, Araújo D, Alves E, Lopes A (2006) Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg 16(12):1645–1655

    Article  Google Scholar 

  5. Gigante G, Martines G, Franco I, Capuano P, Memeo V (2014) Short- and medium-term outcomes of laparoscopic sleeve gastrectomy: a single center experience. G Chir 35(7–8):200–201

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Karaman K, Aziret M, Bal A, Öter V, Ercan M, Bostancı EB (2018) Porto-mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and systematic review of the 104 cases. Obes Res Clin Pract 12(3):317–325

    Article  Google Scholar 

  7. James AW, Rabl C, Westphalen AC, Fogarty PF, Posselt AM, Campos GM (2009) Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review. Arch Surg 144(6):520–526

    Article  Google Scholar 

  8. Ay C, Tengler T, Vormittag R, Simanek R, Dorda W, Vukovich T, Pabinger I (2007) Venous thromboembolism – a manifestation of the metabolic syndrome. Haematologica 92:374–380

    Article  CAS  Google Scholar 

  9. Salinas J, Barros D, Salgado N, Viscido G, Funke R, Pérez G, Pimentel F, Boza C (2014) Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Surg Endosc 28(4):1083–1089

    Article  Google Scholar 

  10. Villagrán R, Smith G, Rodriguez W, Flores C, Cariaga M, Araya S, Yañez M, Fuentes P, Linares J, Zapata A (2016) Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy: incidence, analysis and follow-up in 1236 consecutive cases. Obes Surg 26(11):2555–2561

    Article  Google Scholar 

  11. Simper SC, Erzinger JM, McKinlay RD, Smith SC (2010) Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome. Surg Obes Relat Dis 6(6):684–688

    Article  Google Scholar 

  12. Alsina E, Ruiz-Tovar J, Alpera MR, Ruiz-García JG, Lopez-Perez ME, Ramon-Sanchez JF, Ardoy F (2014) Incidence of deep vein thrombosis and thrombosis of the portal-mesenteric axis after laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 24(9):601–605

    Article  Google Scholar 

  13. Li W, Salcedo V, Buendia J, Le C (2014) A survivor of chronic disseminated intravascular coagulation (DIC) after a gastric bypass surgery. Austin J Clin Case Rep 1:1042

    Google Scholar 

  14. Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688

    Article  CAS  Google Scholar 

  15. Ozkan U, Oğuzkurt L, Tercan F, Tokmak N (2006) Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 12:105–107

    PubMed  Google Scholar 

  16. Keung CH, Gander JW, Zitsman JL (2015) Mesenteric venous thrombosis following vertical sleeve gastrectomy in an adolescent. Surg Obes Relat Dis 11(2):e23–e26

    Article  Google Scholar 

  17. Sethi M, Patel K, Zagzag J, Parikh M, Saunders J, Ude-Welcome A, Somoza E, Schwack B, Kurian M, Fielding G, Ren-Fielding C (2016) Thirty-day readmission after laparoscopic sleeve gastrectomy-a predictable event? J Gastrointest Surg 20(2):244–252

    Article  Google Scholar 

  18. Cesaretti M, Elghadban H, Scopinaro N, Papadia FS (2015) Porto mesenteric venous thrombosis: a nearly postoperative complication after laparoscopic biliopancreatic diversion. World J Gastroenterol 21(8):2546–2549

    Article  Google Scholar 

  19. Darcy DG, Charafeddine AH, Choi J, Camacho D (2015) Portomesenteric vein thrombosis, bowel gangrene, and bilateral pulmonary artery embolism two weeks after laparoscopic sleeve gastrectomy. CaseRep Surg 2015:705610

    Google Scholar 

  20. Baba M, Fakhoury J, Syed A (2015) Portal vein thrombosis due to prothrombin gene mutation following sleeve gastrectomy. Case Rep Gastrointest Med 2015:816914

    PubMed  PubMed Central  Google Scholar 

  21. Carter CO, Fernandez AZ, McNatt SS, Powell MS (2016) Conversion from gastric bypass to sleeve gastrectomy for complications of gastric bypass. Surg Obes Relat Dis 12(3):572–576

    Article  Google Scholar 

  22. Bhatia P, John SJ, Kalhan S, Bindal V (2015) Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a call for prevention. J Minim Access Surg 11(4):276–278

    Article  Google Scholar 

  23. Muneer M, Abdelrahman H, El-Menyar A et al (2016) Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy: 3 case reports and a literature review. Am J Case Rep 17:241–247

    Article  Google Scholar 

  24. Mittal T, Pulle MV, Dey A, Malik VK (2015) Porto mesenteric thrombosis: an uncommon complication after laparoscopic sleeve gastrectomy. J Obes Metab Res 2:35–36

    Article  Google Scholar 

  25. Jkeim NA, Hazmi AA, Alawad A, Ibrahim R, Abudamis A, Tawfik S et al (2015) Portal vein thrombosis following laparoscopic sleeve gastrectomy: a rare case report. Int J Case Rep Images 6:556–559

    Article  Google Scholar 

  26. Carli T, Pintar T (2016) Splanchnic vein thrombosis – an uncommon complication after laparoscopic sleeve gastrectomy. Obes Facts 9(2):138–143

    Article  Google Scholar 

  27. Belnap L, Rodgers GM, Cottam D, Zaveri H, Drury C, Surve A (2016) Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management. Surg Obes Relat Dis 12(10):1787–1794

    Article  Google Scholar 

  28. Wolter S, Dupree A, Coelius C et al (2017) Influence of liver disease on perioperative outcome after bariatric surgery in an Northern German cohort. Obes Surg 27(1):90–95

    Article  Google Scholar 

  29. Bridges F, Gibbs J, Hoehmann C Laparoscopic sleeve gastrectomy complicated by portomesenteric vein thrombosis: a case series. Obes Surg

  30. Alshreadah S, Alotaibi R, Aldabaeab A, Alhafid I (2018) Thrombosis of the spleno-mesentiric portal axis following laparoscopic sleeve gastrectomy: a rare case report. Int J Surg Case Rep 43:29–31

    Article  Google Scholar 

  31. El-Matbouly MA, Khidir N, Touny HA, El Ansari W, Al-Kuwari M, Bashah M (2018 Feb) A 5-year follow-up study of laparoscopic sleeve gastrectomy among morbidly obese adolescents: does it improve body image and prevent and treat diabetes? Obes Surg 28(2):513–519

    Article  Google Scholar 

  32. van't Riet M, Burger JW, van Muiswinkel JM et al (2000) Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg 87(9):1229–1233

    Article  Google Scholar 

  33. Joh JH, Kim DI (2005) Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 29:204–208

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the Radiology Department of our institute for the descriptions of the CT images.

Author information

Authors and Affiliations

  1. General Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Bari, Piazza Giulio Cesare 11, 70125, Bari, Italy

    Fedele Salvatore, Carlino Chiara, Panzera Piercarmine & Martines Gennaro

  2. Vascular Surgery Unit, Azienda Ospedaliero Universitaria Policlinico Bari, Piazza Giulio Cesare 11, Bari, Italy

    Delvecchio Antonella

Authors
  1. Fedele Salvatore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Delvecchio Antonella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlino Chiara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Panzera Piercarmine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martines Gennaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martines Gennaro.

Ethics declarations

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salvatore, F., Antonella, D., Chiara, C. et al. Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature. Indian J Surg 81, 582–586 (2019). https://doi.org/10.1007/s12262-019-01976-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-019-01976-3

Keywords

Search

Navigation