Juniku-Shkololli Argjira, Gjikolli Bujar, Hoti Kreshnike Dedushi, Hyseni Guri, Kadrijaj Fatbardh, Lahu Flamur, Gjikolli Dea, Hyseni Fjolla, Musa Juna
Clinic of Gastroenterology, University of Pristina-University Clinical Centre of Kosovo, Pristina, Kosovo.
Clinic of Radiology, University of Pristina-University Clinical Centre of Kosovo, Pristina, Kosovo.
Radiol Case Rep. 2023 Jun 21;18(9):3020-3025. doi: 10.1016/j.radcr.2023.05.075. eCollection 2023 Sep.
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/m), 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 × 10 /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.
腹腔镜袖状胃切除术（LSG）已成为减轻体重和治疗病态肥胖的常用手术。该手术包括腹腔镜下切除胃大弯的75%以上，从而导致早期饱腹感和神经激素变化，共同促进有效的体重减轻。我们报告一例LSG术后罕见的肠系膜上静脉血栓形成（SMVT）和脾静脉并发症，继而出现肠缺血，通过开腹手术和适当的抗凝治疗得以治愈。一名56岁的肥胖女性（BMI为42.5kg/m），有30年吸烟史，在LSG手术后2周因腹痛、发热、恶心和呕吐等症状就诊于急诊科。她的白细胞计数为15.5（正常值：3.8 - 10.4×10⁹/µL），而C反应蛋白水平为193（正常值：0.0 - 6.0mg/L），D - 二聚体水平为4.69（正常值：0 - 0.50mg/L）。腹部增强CT显示肠系膜上静脉和脾静脉有充盈缺损，肝周和Douglas窝有游离液体，以及小肠增厚。进行了开腹手术，切除了80cm坏死的肠段。尽管术后腹泻持续了4个月，但术后恢复相对顺利。导致这种并发症发生的最常见原因包括：高凝状态、脱水、手术过程中腹内压升高以及其他次要因素。主要症状是腹痛，其次是恶心、呕吐、腹泻和胃肠道出血。对于LSG术后出现腹痛且炎症指标升高的患者，应考虑SMVT和脾静脉血栓形成（SVT）这一可能的并发症。通过CT成像早期诊断并迅速进行抗凝治疗被认为可减少诸如肠梗死和门静脉高压等进一步的并发症。
