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

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.