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Reminder of important clinical lesson
CASE REPORT
Portomesenteric venous thrombosis complicated by a haemorrhagic shock: a rare complication of laparoscopic gastrectomy
  1. Eddie Copelin1,2,
  2. Rosann Cholankeril1,
  3. Ponnandai Somasundar1,
  4. George Cholankeril2,3
  1. 1Department of Internal Medicine, Roger Williams Medical Center, Providence, Rhode Island, USA
  2. 2Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  1. Correspondence to Dr George Cholankeril, gcholankeril{at}gmail.com

Summary

Portomesenteric venous thrombosis is a rare complication reported in only a few cases involving laparoscopic bariatric surgery. We report a case of a 44-year-old woman who presented 14 days after recent laparoscopic sleeve gastrectomy with the chief complaint of abdominal pain and associated nausea. Abdominal CT demonstrated thrombi in her superior mesenteric, portal and splenic veins. She was initiated on therapeutic heparin but developed haemorrhagic shock shortly afterwards. Subsequent CT angiogram failed to localise the source of her haemorrhage. Her haemodynamic instability improved following a 6-day intensive care unit stay requiring vasopressive agents and blood transfusions. Further hypercoagulable workup revealed that she was a heterozygous carrier of the prothrombin gene mutation, and thus started on lifelong oral anticoagulation.

  • Haematology (incl blood transfusion)
  • Obesity (nutrition)
  • Surgery

https://doi.org/10.1136/bcr-2016-219167

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    Footnotes

    • Contributors EC, RC and PS conducted the case report including the literature research. EC prepared the case report with intellectual input from RC. All authors approved the final case report. We would like to thank GC for his editorial support during the preparation of this case report.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.