Defecation-Induced Splenic Rupture in a Patient With Portal Vein Thrombosis After Sleeve Gastrectomy: Case Report and Literature Review

Sleeve gastrectomy is the most commonly performed bariatric surgery, with a relatively high safety profile. Splenic rupture following portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy is a rare life-threatening complication. A morbidly obese 38-year-old female patient presented with acute onset abdominal pain 13 days after a laparoscopic sleeve gastrectomy. Radiological studies revealed portal vein thrombosis (PVT) and splenic hematoma. On the second day of hospitalization, while under observation with stable vital signs, the patient developed sudden hypotension and tachycardia after defecation. Emergency diagnostic tests revealed a splenic rupture, and an emergency laparotomy and splenectomy were performed. The patient received low-molecular-weight heparin (LMWH) and was discharged uneventfully 10 days after surgery. Patients who develop PVT after bariatric surgery should be closely monitored due to the risk of splenic rupture, especially in situations that cause intra-abdominal pressure changes such as defecation.