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Portomesenteric venous thrombosis: A rare but probably under-reported complication of laparoscopic surgery: A case
Yan Mei Goh1, Ajay Tokala2, Tarek Hany3
1Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK.
Abstract:
Portomesenteric venous thrombosis (PMVT) is a rare but well-reported complication following laparoscopic surgery. We present three cases of PMVT following laparoscopic surgery. Our first case is a 71-year-old morbidly obese woman admitted for elective laparoscopic giant hiatus hernia (LGHH) repair. Post-operatively, she developed multi-organ dysfunction and computed tomography scan revealed portal venous gas and extensive small bowel infarct. The second patient is a 51-year-old man with known previous deep venous thrombosis who also had elective LGHH repair. He presented 8 weeks post-operatively with severe abdominal pain and required major bowel resection. Our third case is an 86-year-old woman who developed worsening abdominal tenderness 3 days after laparoscopic right hemicolectomy for adenocarcinoma and was diagnosed with an incidental finding of thrombus in the portal vein. She did not require further surgical intervention. The current guidelines for thromboprophylaxis follow-up in this patient group may not be adequate for the patients at risk. Hence, we propose prolonged period of thromboprophylaxis in the patients undergoing major laparoscopic surgery.
Insights
Portomesenteric venous thrombosis (PMVT) is a rare complication after laparoscopic surgery. Prolonged thromboprophylaxis may be needed for high-risk patients undergoing major laparoscopic procedures.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Surgical Oncology
Background:
- Portomesenteric venous thrombosis (PMVT) is a rare complication following laparoscopic surgery.
- Current thromboprophylaxis guidelines may not adequately address patients at risk for PMVT post-laparoscopy.
Observation:
- Three cases of PMVT following laparoscopic surgery are presented.
- Case 1: 71-year-old obese woman post-laparoscopic giant hiatus hernia repair developed multi-organ dysfunction and small bowel infarct.
- Case 2: 51-year-old man with prior DVT underwent LGHH repair and presented with severe abdominal pain requiring bowel resection.
- Case 3: 86-year-old woman developed abdominal tenderness post-laparoscopic right hemicolectomy, with incidental portal vein thrombus.
Findings:
- PMVT can occur after various laparoscopic procedures, including hernia repair and colectomy.
- Patient outcomes varied, with some requiring extensive intervention (bowel resection) and others managed conservatively.
- Risk factors such as obesity and prior DVT may increase susceptibility to PMVT.
Implications:
- The study suggests current thromboprophylaxis protocols may be insufficient for high-risk patients.
- Prolonged thromboprophylaxis is proposed for patients undergoing major laparoscopic surgery.
- Further research is needed to refine risk stratification and prophylaxis strategies for PMVT post-laparoscopy.
