Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2546-2549
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2546
Portomesenteric venous thrombosis: An early postoperative complication after laparoscopic biliopancreatic diversion
Manuela Cesaretti, Hosam Elghadban, Nicola Scopinaro, Francesco Saverio Papadia
Manuela Cesaretti, Hosam Elghadban, Nicola Scopinaro, Francesco Saverio Papadia, Department of Surgery, San Martino Hospital, University of Genoa, 16132 Genoa, Italy
Author contributions: Elghadban H designed the report; Cesaretti M collected the patient data; Scopinaro N analyzed data; Papadia FS, Elghadban H and Cesaretti M wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manuela Cesaretti, MD, Department of Surgery, Ospedale San Martino, University of Genoa, Largo Rosanna Benzi 8, 16132 Genoa, Italy. manuela.csr02@gmail.com
Telephone: +39-340-3287865 Fax: +39-10-662935
Received: January 27, 2014
Peer-review started: January 29, 2014
First decision: February 14, 2014
Revised: March 15, 2014
Accepted: April 23, 2014
Article in press: May 23, 2014
Published online: February 28, 2015
Abstract

The number of bariatric operations, as well as the incidence of perioperative complications, has risen sharply in the past ten years. Perioperative acute portal vein thrombosis is an infrequent and potentially severe postoperative complication that has not yet been reported after biliopancreatic diversion (BPD). Three cases are presented of portal vein thrombosis that occurred following BPD treatment for morbid obesity and type 2 diabetes. The thromboses were detected by abdominal ultrasound and computed tomography with intravenous contrast. The portomesenteric venous thromboses in all three cases presented as unexpected abdominal pain several days after discharge from the hospital. The complications occurred despite adequate perioperative prophylaxis and progressed to bowel gangrene in the diabetic patients only. These cases demonstrate the occurrence of this rare type of complication, which may be observed by physicians that do not routinely treat bariatric patients. Awareness of this surgical complication will allow for early diagnosis and prompt initiation of adequate therapy.

Keywords: Portal thrombosis, Laproscopy, Bariatric surgery, Biliopancreatic diversion

Core tip: As the number of bariatric operations has risen sharply in the past ten years, severe postoperative complications are likely to occur more frequently. Perioperative acute portal vein thrombosis is one such potential complication that has not yet been reported after biliopancreatic diversion. The first reported cases of portal vein thrombosis following laparoscopic biliopancreatic diversion are described, which occurred early in the postoperative period despite adequate perioperative prophylaxis. An early diagnosis made by abdominal ultrasound and computed tomography will allow for prompt initiation of adequate therapy.