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Case of the Month – January 2020

By Dr Kerry McMahon

History:

Eight weeks post gastric sleeve procedure. Two weeks’ history of nausea and abdominal discomfort.

Imaging:

Portal venous phase CT abdomen and pelvis.

Findings:

The CT showed extensive thrombosis of the Superior Mesenteric Vein (SMV) and Portal vein including intrahepatic branches. This led to central low hepatic density due to altered vascular inflow into the liver. No collection around the Sleeve Gastrectomy suture line or free gas was evident.

Comment:

Portal vein thrombosis is a relatively rare complication of gastric sleeve bariatric surgery, however with the increasing number of patients undergoing this procedure it is being seen more frequently. It is potentially fatal if not diagnosed and treated. Presentation is generally non specific with vague abdominal pain, nausea and vomiting 3-6 weeks post surgery. Therapeutic anti coagulation is recommended in non cirrhotic patients.

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