Amanda Fazzalari, MD1, Laura Tafuri, MS, III1, Vladimir Coca-Soliz, MD2, Shady Macaron, MD, FACS1. 1Saint Mary’s Hospital, 2University of Maryland
Background: Portal vein thrombosis (PVT) is a rare post-operative complication, which has been associated with a wide range of precipitating factors. Most commonly described associated conditions include; cirrhosis, bacteremia, myeloproliferative disorders and hypercoagulable states. PVT most frequently occurs as a complication after hepatobiliary surgery, and although possible, very few cases have been documented occurring after laparoscopic surgery of the gastrointestinal tract. Herein, we describe a case of PVT in a patient who underwent elective laparoscopic right hemicolectomy and was treated successfully at our center.
Case: A 39 year-old female with past medical history of depression, migraines and endometriosis underwent an uncomplicated laparoscopic right hemicolectomy at our facility, for recurrent right-sided diverticulitis. She had suffered 4 previous episodes of diverticulitis and desired definitive surgical treatment. Her hospital course was uneventful and she was discharged to home on post-operative day 2. On post-operative day 9, she presented to the emergency department complaining of severe abdominal pain, back pain and nausea. Computed tomography of abdomen and pelvis revealed PVT. She was initiated on therapeutic anticoagulation with heparin. Hematology was consulted for hypercoagulable workup. Further investigation revealed that she had a family history of a brother who had had a lower extremity deep venous thrombosis, with negative hypercoagulable workup. She had also previously been taking leuprolide and conjugated estrogen and medroxyprogesterone for her endometriosis. She was ultimately found to have a heterozygous prothrombin G20210A gene mutation. Her anticoagulation was bridged to Coumadin and she was discharged home. She has recovered as expected, without any further complications.
Discussion: Although more common in patients with cirrhosis after hepatobiliary surgery, PVT is a rare complication that can occur after virtually all types laparoscopic surgeries, including elective right hemicolectomy. Patients may be completely asymptomatic, or present with a broad spectrum of symptoms including; severe abdominal pain, fever, diarrhea, or gastrointestinal bleeding. Physicians should be aware of this possible complication, since early diagnosis and treatment is imperative to prevent life-threatening complications, such as intestinal ischemia and perforation. A detailed medical and family history is imperative, and all patients with post-operative PVT should undergo complete hypercoagulability workup.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87498
Program Number: P158
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster