Şen Ozan, Kara Simay, Türkçapar Ahmet Gökhan
Türkçapar Bariatrics, Obesity Center, Dikilitaş Mah. Ayazmadere cad, Yeşil Çimen sok no: 9, Beşiktaş, 34394, İstanbul, Turkey; Nişantaşı University, Department of Health Sciences, Maslak mah. Söğütözü sok. no: 20, Maslak 1453, Sarıyer, 34398, İstanbul, Turkey.
Acibadem Fulya Hospital, Radiology Department, Hakkı yeten cad. Yeşilçimen sok. No: 23, 34349, İstanbul, Turkey.
Int J Surg Case Rep. 2021 Feb;79:424-427. doi: 10.1016/j.ijscr.2021.01.086. Epub 2021 Jan 26.
İNTRODUCTION AND IMPORTANCE: Porta-mesenteric vein thrombosis (PMVT) is a rare but fatal complication in patients who are undergoing bariatric surgery. In this report, we present a rare case of a PMVT after laparoscopic sleeve gastrectomy (LSG).
A 52-year-old male patient with a body mass index of 42 kg/m was admitted to our clinic for morbid obesity. Standart LSG was performed with 5 trocar technique. 15 days after LSG, the patient admitted to the emergency department with complaints of abdominal pain, nausea and vomiting. The patient was dehydrated. His C-reactive protein level was 138 mg/L. Abdominal computerized tomography with contrast was performed and showed thickening of a part of small bowel wall in 10 cm length. Also, major trombosis were detected in the superior mesenteric vein branches and portal vein. The patient was hospitalized and 2 × 10,000 IU/1.0 mL high dosage low moleculer weight heparin (LMWH) therapy was initiated. The patient's clinical signs recovered rapidly following treatment.
İn LSG, if the gastroepiploic venous arcus, which runs along the greater curvatura, and has a direct connection to the portal circulation is damaged, a local thrombus may form and move towards the portal system over time. Dehydration is another significant predisposing factor for PMVT. Some patients may develop life-threatening intestinal ischemia. Abdominal tomography with contrast plays a major role in diagnosis.
PMVT should be considered as a serious complication after LSG in patients with abdominal pain. With early diagnosis and anticoagulant therapy, patients's clinical symptoms may improve quicly.
引言与重要性：肠系膜门静脉血栓形成（PMVT）是肥胖症手术患者中一种罕见但致命的并发症。在本报告中，我们呈现了一例腹腔镜袖状胃切除术（LSG）后发生PMVT的罕见病例。
一名体重指数为42kg/m²的52岁男性患者因病态肥胖入住我院。采用5孔技术进行了标准的LSG。LSG术后15天，患者因腹痛、恶心和呕吐主诉入住急诊科。患者脱水。其C反应蛋白水平为138mg/L。进行了腹部增强计算机断层扫描，显示小肠壁一部分增厚10cm。此外，在肠系膜上静脉分支和门静脉中检测到主要血栓形成。患者住院并开始使用2×10,000IU/1.0mL高剂量低分子肝素（LMWH）治疗。治疗后患者的临床症状迅速恢复。
在LSG中，如果沿着大弯走行且与门静脉循环直接相连的胃网膜静脉弓受损，可能会形成局部血栓，并随着时间推移向门静脉系统移动。脱水是PMVT的另一个重要诱发因素。一些患者可能会发展为危及生命的肠缺血。腹部增强断层扫描在诊断中起主要作用。
对于腹痛患者，PMVT应被视为LSG后的一种严重并发症。通过早期诊断和抗凝治疗，患者的临床症状可能会迅速改善。
