Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
Obes Res Clin Pract. 2018 May-Jun;12(3):317-325. doi: 10.1016/j.orcp.2017.12.002. Epub 2018 Jan 5.
Porto-mesenteric venous thrombosis (PMVT) is a rare but fatal complication after bariatric surgery. However, an increasing number of PMVT complications have been observed in the last years after laparoscopic sleeve gastrectomy (LSG) operations.
A 35-year-old male was admitted to the emergency clinic in a septic status with a sudden once of abdominal pain and vomiting. The patient underwent laparoscopic sleeve gastrectomy (LSG) 15 days ago. His physical examination revealed diffuse abdominal tenderness. Abdominal computerised tomography showed a thrombus which was elongated from vena mesenterica superior to vena porta. An emergent laparotomy was performed. A 40 cm of ischemic small bowel segment which began at the 60th cm of Treitz ligament was resected. The gastrointestinal continuity was provided by an end-to-end anastomosis. Patient's postoperative course was uneventful. He was discharged on the 7th postoperative day and was medicated on oral anticoagulation (Warfarin 5 mg/day) for six months.
A total of 104 morbidly obese patients who developed PMVT after bariatric surgery are reported in the English literature between 2004 and April 2017. Most of the patients were female (63 cases, 60.5%). The median age was 42.5 years (14-68) and the median body mass index (BMI) was 44 kg/m (31.8-74.6). The most common cause of coagulopathy disorders was protein C and/or S deficiency (9.6%) followed by prothrombin gene mutation (6.7%). LSG was performed in 83 patients (78.8%) and the median intraoperative pressure was 15 mmHg (14-20). The median operation time was 70 min (min-max: 37-192). Fifty-five patients (52.8%) underwent preoperative oral anticoagulant prophylaxis. The median time for PMVT development was 14 days (min-max: 1-453). Of the 104 patients with PMVT, 75 cases (72.1%) underwent postoperative anticoagulant agents such as low-molecular weight heparin (LMWH), heparin drip or infusion, streptokinase or warfarin, whereas the remaining did not receive prophylactic medication.
PMVT after sleeve gastrectomy is a rare but fatal complication. Therefore, anti-coagulation prophylaxis with LMWH should be considered at least one month postoperatively.
门肠系膜静脉血栓形成（PMVT）是减重手术后罕见但致命的并发症。然而，近年来腹腔镜袖状胃切除术（LSG）手术后观察到越来越多的 PMVT 并发症。
一名 35 岁男性因突发腹痛和呕吐，以败血症状态被收入急诊。患者在 15 天前行腹腔镜袖状胃切除术（LSG）。他的体格检查显示弥漫性腹部压痛。腹部计算机断层扫描显示血栓从肠系膜上静脉延伸至门静脉。紧急剖腹手术。切除了从 Treitz 韧带第 60 厘米开始的 40 厘米缺血性小肠段。胃肠道连续性通过端对端吻合术提供。患者术后恢复顺利。他在术后第 7 天出院，并接受口服抗凝剂（华法林 5mg/天）治疗 6 个月。
2004 年至 2017 年 4 月，英文文献共报道 104 例接受减重手术后发生 PMVT 的病态肥胖患者。大多数患者为女性（63 例，60.5%）。中位年龄为 42.5 岁（14-68 岁），中位体重指数（BMI）为 44kg/m（31.8-74.6）。最常见的凝血功能障碍原因是蛋白 C 和/或 S 缺乏（9.6%），其次是凝血酶原基因突变（6.7%）。83 例患者（78.8%）行 LSG，术中压力中位数为 15mmHg（14-20mmHg）。中位手术时间为 70 分钟（min-max：37-192 分钟）。55 例患者（52.8%）术前接受口服抗凝预防。PMVT 发展的中位时间为 14 天（min-max：1-453 天）。在 104 例 PMVT 患者中，75 例（72.1%）术后接受低分子肝素（LMWH）、肝素滴注或输注、链激酶或华法林等抗凝药物治疗，而其余患者未接受预防性药物治疗。
袖状胃切除术后 PMVT 是一种罕见但致命的并发症。因此，至少应在术后一个月考虑 LMWH 抗凝预防。
