A Rare Cause of Abdominal Pain After Laparoscopic Sleeve Gastrectomy: Portomesenteric and Splenic Vein Thrombosis

2021 ◽  
Author(s):  
Gül Bora Makal ◽  
Osman Yıldırım
Keyword(s):  
Abdominal Pain ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Splenic Vein ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis

Portomesenteric thrombosis after robotic sleeve gastrectomy

2020 ◽  
Vol 13 (12) ◽  
pp. e236202
Author(s):  
Omkaar Jaikaran ◽  
Derek Lim ◽  
Brian Binetti ◽  
Vadim Meytes
Keyword(s):  
Sleeve Gastrectomy ◽  
Portal Vein ◽  
Methylenetetrahydrofolate Reductase ◽  
Splenic Vein ◽  
Subsequent Development ◽  
Obese Women ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Robotic Sleeve Gastrectomy ◽  
Compound Mutation

Portomesenteric thrombosis is an important but rarely reported complication following bariatric surgery. It has been suggested that the incidence of portal vein thrombosis is directly related to many risk factors inherent in the bariatric population as well as factors related to local and systemic effects of laparoscopic surgery. Possible aetiologies vary from systemic inherited hypercoagulable states to a direct inflammatory reaction of portosystemic vessels. Here we present a case report of a 47-year-old obese women who underwent a robotic sleeve gastrectomy with subsequent development of a main portal vein, complete right intrahepatic portal vein and splenic vein thrombosis ultimately found to have a compound mutation of the methylenetetrahydrofolate reductase C677T and A1298C alleles.

scholarly journals Hydatid cyst of the pancreas causing both acute pancreatitis and splenic vein thrombosis

2018 ◽  
Vol 100 (7) ◽  
pp. e178-e180 ◽  
Author(s):  
O Ozsay ◽  
F Gungor ◽  
Serkan Karaisli ◽  
Ibrahim Kokulu ◽  
Osman Nuri Dilek
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Hydatid Cyst ◽  
Splenic Vein ◽  
Final Diagnosis ◽  
Pathological Examination ◽  
Preoperative Imaging ◽  
Splenic Vein Thrombosis ◽  
External Compression ◽  
Vein Thrombosis

Hydatid cyst of the pancreas is a rarely seen entity even in endemic countries. Cyst may causes several symptoms due to external compression or fistulisation to pancreaticobiliary tract or small bowel. A 23-year-old female patient was referred with a complaint of abdominal pain. Preoperative imaging revealed an undefined cyst in the tail of pancreas. She underwent distal pancreatectomy and splenectomy, with a diagnosis of acute pancreatitis due to cystopancreatic duct fistula and also left-sided portal hypertension due to splenic vein thrombosis. Pathological examination reported a final diagnosis of hydatid cyst. To the best of our knowledge, coincidence of cystopancreatic duct fistula and splenic vein thrombosis due to pancreatic hydatid cyst has not previously been reported.

scholarly journals Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Murad Baba ◽  
Jordan Fakhoury ◽  
Amer Syed
Keyword(s):  
Morbid Obesity ◽  
Abdominal Pain ◽  
Sleeve Gastrectomy ◽  
Portal Vein ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Gene Mutation ◽  
Portal Vein Thrombosis ◽  
Vein Thrombosis ◽  
Prothrombin Gene Mutation ◽  
Prothrombin Gene

Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG). It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT) after LSG.Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation.Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

Etiology and Management of Splenic Infarction and Splenic Vein Thrombosis: Unusual Causes of Abdominal Pain in Sickle Cell Trait Patient

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4775-4775 ◽  
Author(s):  
Vladimir Gotlieb ◽  
Shuang Fu ◽  
Prajwol Pathak ◽  
Jeeny Job ◽  
Steve Walerstein ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Splenic Vein ◽  
Splenic Infarction ◽  
Cell Disease ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Splenic Infarct

Abstract Abstract 4775 Abdominal pain is a common complaint among all ages of patients. Splenic infarction and splenic vein thrombosis are rare causes of abdominal pain, usually presenting as left-sided abdominal pain associated with fever, nausea or vomiting, and elevated white blood cell count. CT scan is currently the preferred diagnostic test. Once the diagnosis is identified, the etiology of splenic infarction and/or splenic vein thrombosis should be elicited. Retrospective chart review was conducted in all the patients admitted to our hospital from 2000 till now. Four cases of splenic infarction and/or splenic vein thrombosis were identified (4 males, average age of 45 years, range from 38 to 52 years). Case 1, a 45-year-old male with sickle cell trait (HbS of 38.7%), presented with left upper quadrant pain after 5-hour flight and alcohol binge prior to flight. CT showed splenic infarct and splenic vein thrombosis. Patient received aggressive hydration, abdominal pain resolved and was discharged home. Case 2, a 52-year-old male with renal cell carcinoma, presented with generalized abdominal pain. CT showed splenic infarct. Patient was treated with Coumadin, and routinely followed-up at Oncology clinic. Case 3, a 38-year old male with alcohol abuse and chronic pancreatitis, presented with recurrent abdominal pain and hypersplenism. CT showed splenic vein thrombosis, and the patient underwent splenectomy. Case 4, a 45-year-old male with acute pancreatitis, presented with epigastric pain. CT showed splenic vein thrombosis, and the patient was treated with Coumadin. It is important to reveal the underlying causes for splenic infarction and/or splenic vein thrombosis. Splenic infarction can occur in a variety of settings, including hemoglobinopathy (especially sickle cell disease), hypercoagulable state, embolic disease, malignancy and myeloproliferative disorders. Pancreatitis and pancreatic cancer are the most common causes of splenic vein thrombosis. In general, splenic infarction and/or splenic vein thrombosis can be managed safely with medical treatment, including hydration, oxygenation and pain management. Coumadin can be considered in cancer patients with splenic infarction and in patients with splenic vein thrombosis. Splenectomy is indicated in patients with hypersplenism, splenic sequestration crisis, splenic abscess, splenic rupture, and massive splenic infarction. Splenic infarction in sickle cell disease is usually small and repetitive, leading ultimately to autosplenectomy. Splenic infarction in sickle cell trait is rare. High altitude, vigorous exercise, airplane flight, coexistence with thalassemia or hereditary spherocytosis or severe pyruvate kinase deficiency, can precipitate infarction. Interestingly in our first case, the patient with sickle cell trait developed splenic infarction and non-occlusive thrombus in the distal splenic vein after 5-hour flight. It is possible that the hypoxia associated with the commercial flight caused conformational changes in sickle cells, leading to red blood cells sluggish in the splenic red pulp, and eventually leading to splenic infarction. The alcohol binge resulted in dehydration and hemostasis, leading to splenic vein thrombosis, further perpetuating the vicious cycle. Therefore, we recommend adequate hydration and in-flight oxygen supplementation for sickle cell trait patients taking airplane flight. Further studies need to be done to confirm our hypothesis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Superior mesenteric venous thrombosis as a first manifestation of Antithrombin III deficiency in the postoperative course of laparoscopic sleeve gastrectomy: a case study of 2 patients from 1211 bariatric patients

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Vassilis G Giannakoulis ◽  
Vasiliki Ntella ◽  
Andreas Kiriakopoulos ◽  
Maria Kostrova ◽  
Evangelos Menenakos
Keyword(s):  
Sleeve Gastrectomy ◽  
Venous Thrombosis ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Antithrombin Iii ◽  
Splenic Vein ◽  
Mesenteric Venous Thrombosis ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
Bariatric Patients ◽  
Time Of Presentation

Abstract Superior mesenteric venous thrombosis (SMVT) following laparoscopic sleeve gastrectomy (LSG) is a rare, potentially life-threatening complication, which presents either isolated, or as a part of portal/mesenteric/splenic vein thrombosis. Distinction between them possibly confers an important clinical and prognostic value. Antithrombin III (ATIII) deficiency causes an hypercoagulable state which predisposes to SMVT. We report the clinical presentation and treatment of two patients among 1211 LSGs (incidence = 0.165%) that presented with isolated SMVT and ATIII deficiency in an Academic Bariatric Center. Both patients had an unremarkable past medical history; none was smoker or had a previously known thrombophillic condition/thrombotic episode. Mean time of presentation was 15.5 days after LSG. Despite aggressive resuscitative and anticoagulation measures, surgical intervention was deemed necessary. No mortalities were encountered. Coagulation tests revealed ATIII deficiency in both patients.

scholarly journals Portomesenteric Venous Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Do Energy Systems Pose as Instigating Factor to This Infrequent Complication?

2019 ◽  
Vol 12 ◽  
pp. 117954761984350 ◽  
Author(s):  
Mohammed N Bani Hani ◽  
Abdel Rahman A Al manasra ◽  
Firas Obeidat ◽  
Mamoon H Al-Omari ◽  
Farah Bani Hani
Keyword(s):  
Sleeve Gastrectomy ◽  
Venous Thrombosis ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Splenic Vein ◽  
Energy Systems ◽  
University Hospital ◽  
Published Data ◽  
Vein Thrombosis ◽  
Portomesenteric Venous Thrombosis

Background: Portomesenteric venous thrombosis (PMVT), a rare complication after laparoscopic sleeve gastrectomy (LSG). Severe consequences are owed to a high risk of bowel ischemia. Our aim is to present a series of patients who developed PMVT after LSG, highlighting the potential role of the vessel sealer and divider as a risk factor. Methods: Medical records of seven patients who underwent LSG and developed PMVT from April 2010 to January 2019, at King Abdullah University Hospital and Jordan University Hospital, Jordan were reviewed. Our findings were studied, audited, and compared with published data. Results: A sum of 4900 patients underwent LSG, 7 (0.14%) developed PMVT. The mean age and body mass index (BMI) were 36.8 years and 45 kg/m2, respectively. Four were women. Epigastric pain radiating to the back was the presenting symptom at a median time of 9 days after surgery. Computed tomography (CT) of the abdomen confirmed the diagnosis. Five patients presented with a total portal vein thrombosis (PVT), one with splenic vein thrombosis and one with dual portal and mesenteric vein thrombosis. Conclusion: Portomesenteric venous thrombosis is a relatively uncommon complication following LSG. Early recognition is required to avoid catastrophic outcomes. The role of energy systems in the development of PMVT remains unknown and requires further elaboration.

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