Background

Portomesenteric and splenic venous thrombosis (PMSVT) is a rare, but potentially lethal complication of bariatric surgery. Its risk factors are not fully understood due to its low incidence and the minimal number of case series published. Objective: To report the incidence, patient demographics, risk factors, clinical presentations, treatment, and outcomes of PMSVT following bariatric surgery

Methods

Retrospective, single-center study at a bariatric center of excellence involving 7131 patients. This represents the largest case series in world literature. Patients: 7131 morbidly obese patients underwent Laparoscopic/Robotic bariatric surgery between April 2004 and April 2020. Following their procedure, nine had PMSVT.

Results

A total of 7131 Laparoscopic/robotic bariatric procedures were performed at our center between April 2004 and April 2020. These included 3717 sleeves, 1911 bypasses, 1143 bands and 360 revisional bariatric surgeries. Of this population, 9 (0.13%) patients were diagnosed with PMSVT. Two patients were found to have thrombophilia. New onset abdominal pain was the most common chief complaint, while back pain, nausea, and vomiting, were also present. Thrombi were identified in various combinations of the splenic vein (5 patients), portal vein (8 patients), and superior mesenteric vein (7 patients). Two out of nine patients required operative intervention : 1. bowel resection; 2. splenectomy. Patients were treated by anticoagulation .

Conclusions

Portomesentric and splenic vein thrombosis has a low incidence, but can have potentially significant complications. Due to its vague presentation, a high level of familiarity with the condition's risk factors and presentation is vital for prompt diagnosis and care.