Skip to main content
Top
Published in: Indian Journal of Surgery 6/2019

01-12-2019 | Obesity | Review Article

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

Authors: Fedele Salvatore, Delvecchio Antonella, Carlino Chiara, Panzera Piercarmine, Martines Gennaro

Published in: Indian Journal of Surgery | Issue 6/2019

Login to get access

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.
Literature
1.
go back to reference Robbins MR, Comerota AJ, Pigott JP (2005) Mesenteric venous thrombosis. Vasc Med 10:121–122CrossRef Robbins MR, Comerota AJ, Pigott JP (2005) Mesenteric venous thrombosis. Vasc Med 10:121–122CrossRef
2.
go back to reference 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 148:340–346CrossRef 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 148:340–346CrossRef
3.
go back to reference 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):1422–1431CrossRef 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):1422–1431CrossRef
4.
go back to reference 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):1645–1655CrossRef 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):1645–1655CrossRef
5.
go back to reference 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):200–201PubMedPubMedCentral 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):200–201PubMedPubMedCentral
6.
go back to reference 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):317–325CrossRef 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):317–325CrossRef
7.
go back to reference 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):520–526CrossRef 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):520–526CrossRef
8.
go back to reference Ay C, Tengler T, Vormittag R, Simanek R, Dorda W, Vukovich T, Pabinger I (2007) Venous thromboembolism – a manifestation of the metabolic syndrome. Haematologica 92:374–380CrossRef Ay C, Tengler T, Vormittag R, Simanek R, Dorda W, Vukovich T, Pabinger I (2007) Venous thromboembolism – a manifestation of the metabolic syndrome. Haematologica 92:374–380CrossRef
9.
go back to reference 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):1083–1089CrossRef 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):1083–1089CrossRef
10.
go back to reference 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):2555–2561CrossRef 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):2555–2561CrossRef
11.
go back to reference 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):684–688CrossRef 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):684–688CrossRef
12.
go back to reference 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):601–605CrossRef 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):601–605CrossRef
13.
go back to reference 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 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
14.
go back to reference Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688CrossRef Kumar S, Sarr MG, Kamath PS (2001) Mesenteric venous thrombosis. N Engl J Med 345:1683–1688CrossRef
15.
go back to reference Ozkan U, Oğuzkurt L, Tercan F, Tokmak N (2006) Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 12:105–107PubMed Ozkan U, Oğuzkurt L, Tercan F, Tokmak N (2006) Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 12:105–107PubMed
16.
go back to reference Keung CH, Gander JW, Zitsman JL (2015) Mesenteric venous thrombosis following vertical sleeve gastrectomy in an adolescent. Surg Obes Relat Dis 11(2):e23–e26CrossRef Keung CH, Gander JW, Zitsman JL (2015) Mesenteric venous thrombosis following vertical sleeve gastrectomy in an adolescent. Surg Obes Relat Dis 11(2):e23–e26CrossRef
17.
go back to reference 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):244–252CrossRef 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):244–252CrossRef
18.
go back to reference 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):2546–2549CrossRef 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):2546–2549CrossRef
19.
go back to reference 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 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
20.
go back to reference Baba M, Fakhoury J, Syed A (2015) Portal vein thrombosis due to prothrombin gene mutation following sleeve gastrectomy. Case Rep Gastrointest Med 2015:816914PubMedPubMedCentral Baba M, Fakhoury J, Syed A (2015) Portal vein thrombosis due to prothrombin gene mutation following sleeve gastrectomy. Case Rep Gastrointest Med 2015:816914PubMedPubMedCentral
21.
go back to reference 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):572–576CrossRef 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):572–576CrossRef
22.
go back to reference 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):276–278CrossRef 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):276–278CrossRef
23.
go back to reference 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 17:241–247CrossRef 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 17:241–247CrossRef
24.
go back to reference Mittal T, Pulle MV, Dey A, Malik VK (2015) Porto mesenteric thrombosis: an uncommon complication after laparoscopic sleeve gastrectomy. J Obes Metab Res 2:35–36CrossRef Mittal T, Pulle MV, Dey A, Malik VK (2015) Porto mesenteric thrombosis: an uncommon complication after laparoscopic sleeve gastrectomy. J Obes Metab Res 2:35–36CrossRef
25.
go back to reference 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 6:556–559CrossRef 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 6:556–559CrossRef
26.
go back to reference Carli T, Pintar T (2016) Splanchnic vein thrombosis – an uncommon complication after laparoscopic sleeve gastrectomy. Obes Facts 9(2):138–143CrossRef Carli T, Pintar T (2016) Splanchnic vein thrombosis – an uncommon complication after laparoscopic sleeve gastrectomy. Obes Facts 9(2):138–143CrossRef
27.
go back to reference 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):1787–1794CrossRef 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):1787–1794CrossRef
28.
go back to reference 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):90–95CrossRef 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):90–95CrossRef
29.
go back to reference Bridges F, Gibbs J, Hoehmann C Laparoscopic sleeve gastrectomy complicated by portomesenteric vein thrombosis: a case series. Obes Surg Bridges F, Gibbs J, Hoehmann C Laparoscopic sleeve gastrectomy complicated by portomesenteric vein thrombosis: a case series. Obes Surg
30.
go back to reference 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 43:29–31CrossRef 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 43:29–31CrossRef
31.
go back to reference 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):513–519CrossRef 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):513–519CrossRef
32.
go back to reference 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):1229–1233CrossRef 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):1229–1233CrossRef
33.
go back to reference Joh JH, Kim DI (2005) Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 29:204–208CrossRef Joh JH, Kim DI (2005) Mesenteric and portal vein thrombosis: treated with early initiation of anticoagulation. Eur J Vasc Endovasc Surg 29:204–208CrossRef
Metadata
Title
Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature
Authors
Fedele Salvatore
Delvecchio Antonella
Carlino Chiara
Panzera Piercarmine
Martines Gennaro
Publication date
01-12-2019
Publisher
Springer India
Published in
Indian Journal of Surgery / Issue 6/2019
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI
https://doi.org/10.1007/s12262-019-01976-3

Other articles of this Issue 6/2019

Indian Journal of Surgery 6/2019 Go to the issue

Letter to Editor

Zeal to Heal