A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report
University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA.
*Corresponding author: Erika Leung, MD, MSc. St Luke’s Hospital, Kansas City, MO, USA. Email: Erika.firstname.lastname@example.org
Published: September 12, 2015. DOI: 10.21103/Article5(3)_CRep1
Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern.
Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection.
Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thromboses are normally treated with unfractionated or low-molecular-weight heparin.
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