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Portomesenteric thrombosis after robotic sleeve gastrectomy.
Omkaar Jaikaran1, Derek Lim1, Brian Binetti2
1Department of Surgery, New York University Medical Center, Brooklyn, New York, USA.
BMJ Case Reports
|December 29, 2020
Summary
Portomesenteric thrombosis is a rare complication after bariatric surgery. This case highlights a compound mutation in methylenetetrahydrofolate reductase (MTHFR) as a potential risk factor in a patient who developed extensive portal vein thrombosis.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Genetics
Background:
- Portomesenteric thrombosis is an uncommon complication post-bariatric surgery.
- Risk factors include patient-specific issues and surgical effects.
- Etiologies range from hypercoagulable states to local inflammation.
Observation:
- A 47-year-old obese female underwent robotic sleeve gastrectomy.
- She subsequently developed thrombosis in the main portal vein, right intrahepatic portal vein, and splenic vein.
Findings:
- The patient was found to have a compound mutation in the methylenetetrahydrofolate reductase (MTHFR) gene, specifically the C677T and A1298C alleles.
- This genetic predisposition may contribute to hypercoagulability.
Implications:
- This case underscores the importance of considering genetic thrombophilias in bariatric surgery patients presenting with venous thromboembolism.
- Further research into genetic risk factors for portomesenteric thrombosis post-bariatric surgery is warranted.
- Personalized risk assessment and management strategies may be beneficial.
