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Portomesenteric vein thrombosis after bariatric surgery: a case series
Fernando de Barros1,2, Eduardo de Souza Fernandes2, Nelson Fiod2
1Universidade Federal Fluminense, Departamento de Cirurgia Geral e Especializada - Niteroi - RJ - Brasil.
Objective:
Portomesenteric vein thrombosis (PMVT) is a potentially severe complication that can occur after bariatric surgery. PMVT has gained importance because of the increasing number of bariatric surgeries being performed. to report a rare and severe complication after bariatric surgery, which is difficult to manage. To try to identify common characteristics among the cases and discuss potential causes comparing our data to the available literature.
Methods:
We describe six cases of PMVT in young women with different presentations.
Results:
All six cases occurred in young women 29-41 years old with obesity - body mass index - BMI: 36-39) and weighing 105-121 kg. The patients had few comorbidities (all of which were related to metabolic syndrome) and moderate hepatic steatosis with no sign of cirrhosis. Five patients used oral contraceptives until a few days before the operation. One patient tested positive for thrombophilia. Five patients underwent a laparoscopic sleeve gastrectomy and one underwent a gastric bypass with no complications during the operation (median operating time: 61.3 min, range 52-91 min). The mean duration of follow-up after hospitalization was 12.3 months (range: 7-18 months) and to-date only one patient has had no recanalization.
Conclusion:
The frequency of PMVT appears to be increased in woman and after sleeve gastrectomy. Our findings indicate that patients with abdominal pain weeks after bariatric surgery must be investigated.
Insights
Portomesenteric vein thrombosis (PMVT) is a rare but serious complication following bariatric surgery, particularly in women after sleeve gastrectomy. Persistent abdominal pain weeks post-surgery warrants investigation for PMVT.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Bariatric Surgery Outcomes
Background:
- Portomesenteric vein thrombosis (PMVT) is an increasingly recognized complication after bariatric surgery.
- The rising prevalence of bariatric procedures highlights the need to understand associated risks like PMVT.
Purpose of the Study:
- To report a rare and severe complication, PMVT, following bariatric surgery.
- To identify common characteristics of PMVT cases and explore potential contributing factors.
- To compare findings with existing literature on post-bariatric surgery PMVT.
Main Methods:
- A case series describing six young women who developed PMVT after bariatric surgery.
- Analysis of patient demographics, comorbidities, surgical procedures, and clinical outcomes.
- Review of relevant medical literature to contextualize the findings.
Main Results:
- All six patients were young women (29-41 years) with obesity (BMI 36-39) and few comorbidities.
- Five patients used oral contraceptives pre-operatively; one had a positive thrombophilia test.
- Five underwent laparoscopic sleeve gastrectomy; one had a gastric bypass. One patient has not achieved recanalization after 12.3 months follow-up.
Conclusions:
- The incidence of PMVT may be higher in women and after sleeve gastrectomy.
- Abdominal pain occurring weeks after bariatric surgery necessitates investigation for PMVT.
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