Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany (Drs. Wolk, Weitz, and Distler). Institute for Diagnostic Radiology, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Dresden, Germany (Dr. Plodeck).

ABSTRACT

Portomesenteric venous thrombosis is a rare complication after laparoscopic cholecystectomy. Sufficient management is important for prevention of bowel infarction. We present a severe case of portomesenteric venous thrombosis. Partial thrombosis of the central portal vein, complete thrombosis of the left portal vein and the superior mesenteric vein, as well as venous stasis of the small bowel and the ascending and transverse colon were seen on computed tomography angiography. After surgical thrombectomy and catheter-directed venous thrombolysis, the patient developed rethrombosis of the superior mesenteric vein with an additional thrombosis of the right liver artery. Relaparotomy and a further thrombectomy were performed. Bowel infarction was prevented, and on postoperative day 19, the patient was discharged in good condition. In this case of severe portomesenteric venous thrombosis, we found no thrombophilic disorders and 6 months of anticoagulation were recommended.

Key Words: Laparoscopic cholecystectomy, Portomesenteric venous thrombosis, Risk factors.

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