Gastric Perforation After Laparoscopic Splenectomy and Esophagogastric Devascularization for Portal Hypertension

Abstract

Laparoscopic splenectomy and esophagogastric devascularization (LSED) has been widely used as a novel surgical intervention for portal hypertension, especially in China. Gastric perforation is a rare postoperative complication in this procedure. Symptoms consist of hyperpyrexia, abdominal pain, and abdominal coffee-ground drainage. There are 2 known risk factors including portal hypertensive gastropathy and poor blood supply to the stomach after operation. We described a case of gastric perforation in a male patient who underwent LSED for portal hypertension and severe gastroesophageal varices, secondary to liver cirrhosis. At the seventh day after surgery, some symptoms appeared including fever, left abdominal pain, refractoriness hiccough, and abdominal distention. The diagnosis of gastric perforation was made by upper gastrointestinal tract x-ray radiography. The patient was cured after approximately 2 months by receiving sufficient abdominal drainage, nutritional support, antihepaticcoma, and other expectant treatments, which was confirmed by upper gastrointestinal tract radiography. Gastric perforation is a rare but life-threatening complication after LSED. It is easy to diagnose by its typical symptoms and signs. Although it seems that the emergency laparoscopic operation is the best choice, in view of the high risk due to poor liver function, conservation treatment is also a good selection.