Bhatia Parveen, John Suviraj J, Kalhan Sudhir, Bindal Vivek
Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
J Minim Access Surg. 2015 Oct-Dec;11(4):276-8. doi: 10.4103/0972-9941.152101.
Postoperative portomesenteric venous thrombosis (PMVT) is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.
减重手术后，术后门静脉肠系膜静脉血栓形成（PMVT）的报道越来越多。其表现多样，通常是非特异性的，而且具有危及生命和改变生活的潜在后果，因此必须对其进行预防、早期检测并进行最佳治疗。我们报告了一例50岁的病态肥胖男性，他接受了腹腔镜袖状胃切除术，术后两周出现有症状的PMVT，通过抗凝治疗成功治愈。我们对这种血栓形成实体的病因病理机制提出了假设。越来越多的人认识到肥胖和减重手术会在局部和全身形成促凝状态，这为设计理想的PMVT预防方案提供了动力，PMVT可能比目前认为的更为常见。我们支持对有无法解释或难以治疗的腹部症状的减重手术后患者进行PMVT早期筛查。常规监测的作用以及PMVT后抗凝的理想持续时间尚待阐明。
