Superior mesenteric vein thrombosis as uncommon complication following laparoscopic sleeve gastrectomy: a case report and literature review

Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure with relatively low complication rates. However, portomesenteric venous thrombosis (PMVT) is an uncommon serious complication that can occur after surgery. If not diagnosed early, this condition can lead to intestinal ischemia. We present the case of a 49-year-old woman with obesity (BMI 60.9 kg/m²), hypertension, and diabetes mellitus, who developed PMVT 20 days after undergoing LSG. She presented with severe epigastric pain, nausea, and diarrhea. Imaging revealed thrombosis in the superior mesenteric and portal veins, laboratory tests indicated multiple prothrombotic factors, including factor V Leiden mutation and reduced Antithrombin III levels. The patient was managed with anticoagulation therapy and was discharged on warfarin with close INR monitoring. This case highlights the critical importance of early detection and effective treatment of PMVT after LSG. A multidisciplinary approach, including hematology and vascular surgery consultations, is crucial to prevent complications and improve patient outcomes.