PORTAL VEIN THROMBOSIS AFTER ROBOTIC GASTRIC BYPASS: CASE REPORT AND REVIEW OF THE LITERATURE

Abstract :

Portal vein thrombosis (PVT) is a rare but potentially lethal complication after laparoscopic procedures. Patients with obesity undergoing bariatric surgery are at increased risk of having venous thromboembolism because they have a hypercoagulable and inflammatory state. Clinical manifestations are frequently non-specific; the oad spectrum ranges in asymptomatic patients to life-threatening bowel infarction. We present the case of a female 30 years old with a body mass index (BMI) of 43 kg/m2 refractory to conventional weight-loss treatment. Robotic Roux-en-Y Gastric Bypass has been made without any problem and the postoperative evolution of the patient was uneventful. Postoperative IV contrast CT scan discovered a partial portal vein occlusion. We started Clexane 40mg SC daily since the first postoperative day. After the hematologic protocol the patient was diagnosed with an Antiphospholipid syndrome as the origin of the PVT. Diagnosis and treatment to prevent intestinal ischemia and a potential necrosis should not wait; a high index of suspicion is required. Anticoagulant therapy is generally satisfactory preventing thrombus extension, achieving partial recanalization and avoiding new thrombotic events.

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