Thrombosis of extrahepatic portal vein aneurysm immediately after laparoscopic distal gastrectomy: A case report

An extrahepatic portal vein aneurysm is a rare vascular abnormality that is often asymptomatic but can lead to complications, such as thrombosis. Here, we report the case of an 81-year-old man in whom an aneurysm was incidentally detected during preoperative evaluation for gastric cancer. The patient underwent laparoscopic distal gastrectomy without complications. However, thrombosis in the extrahepatic portal vein was identified on postoperative day 6 using contrast-enhanced computed tomography. Although the D-dimer levels were elevated, liver function remained normal, indicating preserved blood flow. The patient was treated with oral anticoagulation therapy, which led to thrombus resolution and reduced the portal vein aneurysm size. Postoperative changes in blood flow and increased blood coagulability may have contributed to thrombosis. Radiologists should recognize extrahepatic portal vein aneurysm in the preoperative phase of gastrointestinal cancer and consider early postoperative imaging for prompt thrombosis detection. Conservative anticoagulation can be effective if blood flow is preserved, as confirmed via imaging.