Verboonen Sotelo Jóse Sergio, Ponce de León Palomares Jaime, Romero Manzano Jeffry, Pérez Corzo Hector Joaquin, Villalobos López Jesus Antonio, Linden Pérez-Gavilán Gustavo Adolfo, Vega Tostado Guillermo, Verboonen Partida Gabriela
Department of Bariatric Surgery, Obesity Good Bye Center Tijuana, Tijuana, Baja California, Mexico.
Am J Case Rep. 2025 Sep 3;26:e947151. doi: 10.12659/AJCR.947151.
BACKGROUND The prevalence of obesity has more than doubled since 1980. Consequently, bariatric surgery rates have risen significantly, increasing the need to address its complications. Portomesenteric venous thrombosis is a rare but potentially life-threatening complication, accounting for 5% to 15% of all mesenteric ischemic events. This case highlights the importance of considering portomesenteric vein thrombosis as a potential complication in bariatric surgery, especially in patients at high risk. CASE REPORT A 28-year-old woman with grade II obesity underwent elective laparoscopic sleeve gastrectomy. On postoperative day 7, she presented with diarrhea and vomiting (over 10 episodes in a weekend), dry mucosa, vague abdominal pain radiating to the lumbar region, and intolerance to oral intake. After 48 h with no improvement, a contrast-enhanced abdominal and pelvic computed tomography scan (January 7, 2024) revealed intravascular defects in the portal vein, superior mesenteric vein, and splenic vein, suggesting thrombosis. CONCLUSIONS The etiology of portomesenteric vein thrombosis following bariatric surgery is likely multifactorial. While the relationship between venous thromboembolism and obesity is well established, debates persist regarding the optimal duration of medical therapy after discharge, despite the existing preventive measures in the literature. Some 95% of surgeons administer anticoagulants for at least 10 to 14 days postoperatively, while 50% extend prophylaxis for up to 30 days, depending on individual risk factors. While gastric sleeve surgery offers substantial benefits for patients with obesity, the rising incidence of portal mesenteric thrombosis underscores the importance of proactive prevention and early detection strategies.
背景 自1980年以来，肥胖症的患病率增加了一倍多。因此，减肥手术的比例显著上升，这就增加了应对其并发症的需求。门静脉肠系膜静脉血栓形成是一种罕见但可能危及生命的并发症，占所有肠系膜缺血事件的5%至15%。本病例强调了在减肥手术中，尤其是在高危患者中，将门静脉肠系膜静脉血栓形成视为潜在并发症的重要性。病例报告 一名28岁的II级肥胖女性接受了择期腹腔镜袖状胃切除术。术后第7天，她出现腹泻和呕吐（一个周末超过10次）、黏膜干燥、放射至腰部的模糊腹痛以及无法耐受口服摄入。48小时后情况没有改善，2024年1月7日的腹部和盆腔增强计算机断层扫描显示门静脉、肠系膜上静脉和脾静脉存在血管内缺损，提示血栓形成。结论 减肥手术后门静脉肠系膜静脉血栓形成的病因可能是多因素的。虽然静脉血栓栓塞与肥胖之间的关系已得到充分证实，但尽管文献中有现有的预防措施，但关于出院后最佳药物治疗持续时间仍存在争议。约95%的外科医生在术后至少给予抗凝剂10至14天，而50%的医生根据个体风险因素将预防措施延长至30天。虽然袖状胃手术为肥胖患者带来了巨大益处，但门静脉肠系膜血栓形成发病率的上升凸显了积极预防和早期检测策略的重要性。
