Unusual complication following laparoscopic sleeve gastrectomy, a case report

Area of Science:

• Nephrology
• Vascular Surgery
• Bariatric Surgery

Background:

• Venous thromboembolic events (VTE) occur in approximately 1% of bariatric surgery patients.
• Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure.
• Renal infarction is an exceptionally rare complication post-LSG.

Observation:

• A 42-year-old female with obesity and dyslipidemia developed left flank pain and hematuria three days post-LSG.
• Imaging revealed significant left renal infarction (60-70% hypoperfusion) without identified arterial or venous thrombi.
• Laboratory tests showed elevated D-dimer and inflammatory markers, with preserved renal function.

Findings:

• The renal infarction was deemed likely provoked by surgery, obesity, and dehydration, as no underlying structural or hematologic causes were found.
• The patient received six months of therapeutic anticoagulation.
• This represents a non-paradoxical embolism leading to renal infarction.

Implications:

• Highlights the importance of individualized VTE prophylaxis and adequate postoperative hydration in high-risk bariatric patients.
• Underscores the need for vigilant surveillance and prompt diagnosis of rare complications like renal infarction post-LSG.
• Suggests further research is needed to optimize preventative strategies and patient outcomes in bariatric surgery.