Page 50 - World Journal of Laparoscopic Surgery

Portomesenteric Venous Thrombosis with Bowel Ischemia after Laparoscopic Sleeve Gastrectomy

Fig. 2: Abdominal CT scan with contrast showing superior mesenteric Fig. 3: Small bowel gangrenous segment
vein thrombosis (white arrow)

heparin (LMWH) (enoxaparin 80 mg twice/daily) followed by oral indication because the hypertension associated within sufflation
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anticoagulation after discharge (warfarin 5 mg/day) for up to 6 could theoretically worsen venous ischemia. Surgical exploration
months. Histopathological examination revealed gangrenous consents the lesions assessment with two possible outcomes: (1)
necrosis with mesenteric vascular thrombosis in the resected in cases of localized intestinal necrosis, treatment consists of a
jejunal segment. resection and immediate restoration of digestive continuity; (2)
when the ischemic or infarcted intestine segment is extended, the
dIscussIon limits of resection are difficult to predict. In all cases, the resection
The most frequent complications following sleeve gastrectomy should be efficient to avoid “short bowel syndrome.” Some teams
are partisans of a resection followed by a gastrointestinal bypass,
are fistula and hemorrhage. Thrombosis of the superior mesenteric associated with an immediate heparin treatment ensued by a
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vein is exceptional, potentially severe. In this case described second laparotomy 12–24 hours later. 10
above, the diagnosis was made on the 14th postoperative day.
There are multiple risk factors such as genetic predisposition and
hematological factors (factor V Leiden deficiency, protein C and conclusIon
S deficiency), malignancy, immobilization, varicose veins, atrial Portomesenteric vein thrombosis is a complication that has
fibrillation, and venous stasis due to intra-abdominal pressure, potentially life- threatening consequences following laparoscopic
intraoperative manipulation, and/or damage at the splanchnic bariatric surgery. It should be of clinical suspicion as it presents
endothelium, which can lead to PMVT. Diabetes mellitus (DM) is an with nonspecific symptoms. In cases with nonspecific abdominal
important causing factor in the development of atherothrombosis pain after bariatric surgery, possible portal vein thrombosis (PVT)
by dysregulation of several signaling pathways resulting in diagnosis should be kept in mind, and necessary radiological
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enhanced adhesion, activation, and aggregation of the platelets. procedures should be used for early diagnosis and treatment.
Overt hyperthyroidism is also associated with venous thrombosis
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particularly in cerebral and splanchnic veins. The clinical signs of
mesenteric venous ischemia are variable and nonspecific. In the references
presence of abdominal pain of unknown etiology, we shall know 1. Çetinkünar S, Erdem H, Aktimur R, et. al. The effect of laparoscopic
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now mainly medical; in case of early diagnosis and an abdomen 6. Vazzana N, Ranalli P, Cuccurullo C, et al. Diabetes mellitus and
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136 World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019)