Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Introduction: Portomesenteric venous thrombosis (PMVT) is relatively rare surgical complication after laparoscopic and bariatric surgery, with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. The purpose of this article is to present our case of PMVT after laparoscopic sleeve gastrectomy (LSG) and relative discussion of etiology, risk factors and further management. Presentation & Discussion: We present the case of a 42-year-old man who underwent an uncomplicated LSG for the treatment of morbid obesity and presented on postoperative day 15 with vague diffuse abdominal pain, diagnosed with extensive PMVT involving as well the splenic vein. The patient received therapeutic anticoagulation had full hematological workup and investigations. Upon clinical and paraclinical improvement, he was discharged on day 6 of admission on proper anticoagulation. A high index of suspicion for PMVT should be considered in patients reporting diffuse vague abdominal pain after LSG owing to its lethality. Upon confirmation of PMVT, therapy should begin immediately along with extended anticoagulation therapy on discharge. Conclusions: PMVT is relatively uncommon complication in patients undergoing bariatric surgery, but a high index of suspicion for definitive management should be present. Recent Publication 1. Shoar et al. (2018) Portomesentric and splenicvein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients. Surgery for Obesity and Related Diseases 14(1)47–59. 2. Goitein D, Matter I, Raziel A, Keidar A, Hazzan D, Rimon U, et al. (2013) Portomesenteric thrombosis following laparoscopic bariatric surgery: Incidence, patterns of clinical presentation, and etiology in a bariatric patient population. JAMA Surg. 148:340–6. 3. Harnik I G and Brandt L J (2010) Mesenteric venous thrombosis. Vasc Med. 15(5):407–18. 4. Salinas J, Barros D, Salgado N, Viscido G, Funke R, Pérez G, et al. (2014) Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Surg Endosc. 28:1083-9. 5. Speranskaya A, Nicolau J, Olivares J, Pascual S, Gonzalez DeCabo M and Masmiquel L (2013) Mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Clin Obes. 3:56–8.

Biography

Yasser H Tohme is specialized in general, laparoscopic and bariatric surgery. He is a Fellow of the European Board of Surgery (FEBS) and a Member of IFSO, SFCE, EAES, LSGS. He has sub-specialty training in MIS and Bariatric Surgery in Paris, and was granted the Minimally Invasive Digestive Surgery Diploma from University of Paris XI. He is currently a Senior Specialist in Bariatric Surgery, member of the research team and Deputy Chair of M&M Surgical Committee at International Medical Center (IMC), Jeddah, KSA. He has a Post Graduate Diploma in Health Care Management and International Hospital Accreditation.
Email:dr.tohme@hotmail.com