Portomesenteric Vein Thrombosis Following Sleeve Gastrectomy: A Case Report and Literature Review.

Abstract

BACKGROUND The prevalence of obesity has more than doubled since 1980. Consequently, bariatric surgery rates have risen significantly, increasing the need to address its complications. Portomesenteric venous thrombosis is a rare but potentially life-threatening complication, accounting for 5% to 15% of all mesenteric ischemic events. This case highlights the importance of considering portomesenteric vein thrombosis as a potential complication in bariatric surgery, especially in patients at high risk. CASE REPORT A 28-year-old woman with grade II obesity underwent elective laparoscopic sleeve gastrectomy. On postoperative day 7, she presented with diarrhea and vomiting (over 10 episodes in a weekend), dry mucosa, vague abdominal pain radiating to the lumbar region, and intolerance to oral intake. After 48 h with no improvement, a contrast-enhanced abdominal and pelvic computed tomography scan (January 7, 2024) revealed intravascular defects in the portal vein, superior mesenteric vein, and splenic vein, suggesting thrombosis. CONCLUSIONS The etiology of portomesenteric vein thrombosis following bariatric surgery is likely multifactorial. While the relationship between venous thromboembolism and obesity is well established, debates persist regarding the optimal duration of medical therapy after discharge, despite the existing preventive measures in the literature. Some 95% of surgeons administer anticoagulants for at least 10 to 14 days postoperatively, while 50% extend prophylaxis for up to 30 days, depending on individual risk factors. While gastric sleeve surgery offers substantial benefits for patients with obesity, the rising incidence of portal mesenteric thrombosis underscores the importance of proactive prevention and early detection strategies.