Thrombosis of the superior mesenteric vein after laparoscopic sleeve gastrectomy – Case report and review of the literature

Abstract

Introduction

Bariatric surgery is the most effective treatment for patients with obesity. Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. Although complication rate is low, thrombosis of the superior mesenteric vein (SMV) may be a rare but life-threatening complication after bariatric surgery.

Presentation of the case

A 33-year-old female patient, BMI 51.8 kg/m², underwent an uneventful LSG at our center for bariatric and metabolic surgery in Hannover, Germany. 70 mg enoxaparin once daily was given as prophylactic anticoagulation until discharge.

After an uneventful postoperative course and discharge at postoperative day 3, the patient presented 9 days later with epigastric and back pain in the emergency room. The CT scan showed thrombosis of the SMV.

After thrombectomy of the SMV, several abdominal washouts, creation of a laparostoma and highly complex treatment at the intensive care unit the patient was discharged 8 weeks after revisional surgery.

Discussion

The incidence of thrombosis of the SMV after bariatric surgery is low, but mortality is high (up to 50 %). In the literature, only case reports and small series are reported. Possible causes and the management of the disease are variable and depend on the patients´ situation.

Although thrombosis of the SMV is a rare complication after bariatric surgery, it should be considered or ruled out, if a patient presents with abdominal pain after a recently performed bariatric procedure. Treatment should be initiated immediately and may include therapeutic anticoagulation, interventional or surgical procedure.

Conclusion

Even if risk factors for thromboembolic events are unknown, every bariatric surgeon should be aware that patients with obesity are at risk.