The association between bariatric surgery and extensive portal vein thrombosis: A case report

As the obesity rate continues to rise, portal vein thrombosis (PVT) has emerged as a more frequent complication following bariatric surgery, with an incidence reported at approximately 0.4 % according to recent meta-analyses. PVT, characterized by the development of a thrombus within the portal vein, can be life-threatening due to its subtle and often nonspecific symptoms, complicating timely diagnosis and treatment.

In this case report, we present a 45-year-old female patient with a history of morbid obesity who underwent robotic-assisted laparoscopic sleeve gastrectomy and hiatal hernia repair. On postoperative day 16, she developed symptoms of severe abdominal pain and intolerance to oral intake, suggesting the presence of portal vein thrombosis. Laboratory findings showed significantly elevated D-dimer levels, and contrast-enhanced CT imaging confirmed an extensive thrombus within the portal vein. The patient was promptly admitted to the critical care unit, where she was managed conservatively with therapeutic anticoagulation, including subcutaneous heparin preoperatively and postoperatively, and discharged with a prescription for apixaban.

Early diagnosis of PVT in the post-bariatric population is critical, as it allows for timely intervention with evidence-based therapeutic options such as anticoagulation, thereby improving both short- and long-term patient outcomes. This case not only underscores the importance of heightened vigilance for PVT in patients presenting with nonspecific abdominal symptoms after bariatric surgery but also highlights the potential risk factors unique to this patient, such as prolonged operative time and underlying comorbidities, which may have contributed to the thrombotic event. A multidisciplinary approach, involving both medical and surgical teams, is essential for optimal management of such complex cases.

This case underscores the critical importance of early recognition and prompt management of portal vein thrombosis in post-bariatric surgery patients. By emphasizing the role of thorough perioperative DVT prophylaxis, including the use of heparin and sequential compression devices, this report not only aims to improve patient outcomes but also contributes to the growing body of knowledge on the prevention and treatment of PVT in the bariatric population. These insights may serve as a valuable framework for managing similar clinical scenarios in the future.