Background

Background: There have been documented cases of acute portal vein thrombosis (PVT) after laparoscopic sleeve gastrectomy (LSG); however, there are no reports of delayed PVT. Clinical Case: 63-year-old female with a history of cholelithiasis, LSG, diabetes, and hyperlipidemia presented with worsening abdominal pain for four weeks. She reported severe pain in the mid-epigastrium and bilious emesis for two days. The patient was scheduled to have an elective cholecystectomy but was instructed to go to the emergency department after worsening symptoms. Abdominal CT revealed acute extensive thrombosis of the right portal veins, main portal vein, splenic vein, and superior mesenteric vein. Discussion: The cause of PVT is multifactorial, and acute PVT can be seen after a LSG. Suggested causes of PVTs after LSG include: venous stasis from increased abdominal pressure due to insufflation, manipulation of splanchnic vasculature, and increased risk of DVT in the bariatric patient population. In a literature search, James et al1 identified a total of 18 case reports of PVT after laparoscopic surgery. A study done by Goitein et al2, revealed a 0.3% incidence of PVT after LSG. In this study, patients developed thrombosis in 3-42 days (median of 3.7 days.) Both studies included cases in the acute setting, and none were reported in a delayed setting (>1 year after surgery). This patient had a finding of a PVT occurring eight years after a LSG. Without other obvious causes, there is a possibility her PVT was associated with her remote history of an LSG.