A rare complication with superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy: A case report

Argjira Juniku-Shkololli, MD; Bujar Gjikolli, MD; Kreshnike Dedushi Hoti, MD; Guri Hyseni, MD; Fatbardh Kadrijaj, MD; Flamur Lahu, MD; Dea Gjikolli, MD; Fjolla Hyseni, MD; Juna Musa, MD

Radiology Case Reports (Sep 2023)

A rare complication with superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy: A case report

Argjira Juniku-Shkololli, MD,
Bujar Gjikolli, MD,
Kreshnike Dedushi Hoti, MD,
Guri Hyseni, MD,
Fatbardh Kadrijaj, MD,
Flamur Lahu, MD,
Dea Gjikolli, MD,
Fjolla Hyseni, MD,
Juna Musa, MD

Affiliations

Argjira Juniku-Shkololli, MD: Clinic of Gastroenterology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
Bujar Gjikolli, MD: Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo; AAB College – Faculty of Radiology, Prishtina, Kosovo; Corresponding author.
Kreshnike Dedushi Hoti, MD: Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
Guri Hyseni, MD: Department of Pediatric Surgery, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
Fatbardh Kadrijaj, MD: Clinic of Gastroenterology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
Flamur Lahu, MD: Clinic of Radiology, University of Pristina–University Clinical Centre of Kosovo, Pristina, Kosovo
Dea Gjikolli, MD: AAB College – Faculty of Radiology, Prishtina, Kosovo
Fjolla Hyseni, MD: NYU Langone Health, New York, NY, USA
Juna Musa, MD: Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, NY, USA

Journal volume & issue: Vol. 18, no. 9
pp. 3020 – 3025

Abstract

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Laparoscopic sleeve gastrectomy (LSG) has become a frequent procedure to reduce weight and morbid obesity. The procedure involves laparoscopic resection of more than 75% of the greater curvature of the stomach, resulting in early satiety and neuro-hormonal changes that collectively promote effective weight loss. We present a rare case of complication of superior mesenteric vein thrombosis (SMVT) and splenic vein after LSG, with consequent bowel ischemia that was treated with open laparotomy and appropriate anticoagulation therapy. A 56-year-old obese woman (BMI of 42.5 kg/m2), smoker for 30 years, presented to the emergency department with symptoms such as abdominal pain, fever, nausea and vomiting, 2 weeks after LSG intervention. Her white blood cell count was 15.5 (normal values: 3.8-10.4 × 103 /µL), while C- reactive protein level was 193 (normal values: 0.0-6.0 mg/L) and her D-Dimer level 4.69 (normal values: 0-0.50 mg/L). Abdominal CT with contrast showed a filling defect in the superior mesenteric and splenic vein, free perihepatic and Douglas pouch fluid, as well as small bowel thickening. An open laparotomy was performed and the necrotic segment of bowel of 80 cm was removed. The postoperative period went relatively well, despite the diarrhea that continued for the next 4 months after the intervention. The most common causes leading the development of this complication include: hypercoagulable state, dehydration, increased intra-abdominal pressure during the procedure and other secondary factors. The main symptom is abdominal pain, followed by nausea, vomiting, diarrhea and bleeding from the gastrointestinal tract. SMVT and SVT should be considered as a possible complication in patients with abdominal pain and increased inflammatory parameters after LSG. Early diagnosis through CT imaging and rapid anticoagulation therapy is considered to reduce further complications such as intestinal infarction and portal hypertension.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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