Copelin Eddie, Cholankeril Rosann, Somasundar Ponnandai, Cholankeril George
Department of Internal Medicine, Roger Williams Medical Center, Providence, Rhode Island, USA.
Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
BMJ Case Rep. 2017 May 29;2017:bcr-2016-219167. doi: 10.1136/bcr-2016-219167.
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.
门静脉肠系膜静脉血栓形成是一种罕见的并发症，仅在少数涉及腹腔镜减肥手术的病例中有所报道。我们报告一例44岁女性病例，该患者在近期接受腹腔镜袖状胃切除术后14天出现腹痛并伴有恶心的主要症状。腹部CT显示其肠系膜上静脉、门静脉和脾静脉内有血栓形成。她开始接受肝素治疗，但随后不久出现失血性休克。随后的CT血管造影未能确定其出血来源。在重症监护病房住院6天，期间需要使用血管活性药物并输血，之后她的血流动力学不稳定状况有所改善。进一步的高凝状态检查显示她是凝血酶原基因突变的杂合子携带者，因此开始接受终身口服抗凝治疗。
