Acute splanchnic venous thrombosis following laparoscopic sleeve gastrectomy: A case report

Abstract

Introduction and importance

Splanchnic venous thrombosis is a rare but serious complication of bariatric surgery. This case report highlights a unique occurrence of acute portal, mesenteric, and splenic vein thrombosis in a 39-year-old woman three weeks after undergoing laparoscopic sleeve gastrectomy for severe obesity.

Case presentation

A 39-year-old woman with a BMI of 38.1 kg/m² and no prior medical history presented with a six-day history of diffuse abdominal pain, nausea and subjective fever but no change in bowel habits or blood in stool. A CT scan abdomen with IV contrast revealed extensive thrombosis involving the intrahepatic and extrahepatic veins, extending to the portal, splenic, and mesenteric veins. Laboratory findings supported a hypercoagulable state. Treatment included anticoagulation, intravenous antibiotics, supportive care, and close monitoring.

Clinical discussion

Diagnosing SVT is difficult due to its non-specific symptoms, relying on advanced imaging techniques like Doppler ultrasound, CT, or MRI. Anticoagulation therapy, such as low-molecular-weight heparin (LMWH) followed by direct oral anticoagulants (DOACs), is essential for managing SVT. Supportive treatments, including PPIs and antibiotics, improve outcomes, and surgery may be necessary for complicated cases like end organ damage for instance intestinal ischemia and necrosis.

Conclusion

This case underscores the need for high clinical suspicion of splanchnic venous thrombosis in post-bariatric surgery patients presenting with persistent abdominal pain. Proper patient selection and stratification, adequate thromboprophylaxis are crucial preventive strategies. Early diagnosis and aggressive management with multidisciplinary team approach are critical to preventing severe complications and improving outcomes.