Background

To report incidence, presentation, and management of Porto-mesenteric vein thrombosis (PMVT) at our institution.

Methods

A retrospective chart review of 5266 patients undergoing bariatric surgery at our institution between 2014 and 2019 was performed.

Results

Out of 5266 patients, 10 patients (0.19%) developed porto-mesenteric vein thrombosis. Patients who developed PMVT were females from age range of 24 to 55 years and had a BMI range of 36.9 to 47.01. None of these patients were candidates for perioperative venous thromboembolism chemoprophylaxis. The average operative time was 40.2 minutes, and all patients underwent laparoscopic sleeve gastrectomy with one patient requiring a concurrent laparoscopic hiatal hernia repair. There were no intraoperative complications. These patients presented to the hospital with a combination of symptoms including abdominal pain, nausea, vomiting, and back pain.The workup showed thrombophilia in 4 out of 10 patients. One patient needed bowel resection. Another patient underwent laparotomy with splenectomy. The patient requiring bowel resection tested positive for antiphospholipid antibody and was heterozygous for Prothrombin gene mutation and Protein C deficiency. Other patients tested positive for Prothrombin gene mutation or anti-phospholipid antibody. One patient had a diagnosis of non-cirrhotic portal hypertension on follow-up but no current symptoms.

Conclusions

PMVT is a rare but potentially lethal complication. Prompt anticoagulation is the cornerstone of treatment. Timely operative treatment is required to prevent catastrophic outcome in a subset of these patients. Further studies are needed to improve guidelines for thrombophilia screening in bariatric patients