Portal Vein Thrombosis Due to Factor 2 Leiden in the Post-operative Course of a Laparoscopic Sleeve Gastrectomy for Morb
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CASE REPORT
Portal Vein Thrombosis Due to Factor 2 Leiden in the Post-operative Course of a Laparoscopic Sleeve Gastrectomy for Morbid Obesity Bruno Berthet & Emilie Bollon & René Valero & Mehdi Ouaissi & Igor Sielezneff & Bernard Sastre
Received: 12 February 2009 / Accepted: 17 June 2009 / Published online: 15 July 2009 # Springer Science + Business Media, LLC 2009
Abstract Portal vein thrombosis can occur after laparoscopic operations. This complication has not been yet reported after laparoscopic sleeve gastrectomy. We report the case of a patient who presented mild abdominal pains 2 weeks after a laparoscopic sleeve gastrectomy achieved to cure morbid obesity. Computed tomography led to the diagnosis of portal vein thrombosis bound to a genetic disorder due to heterozygote Leiden 2 factor which impaired coagulation. Recommendations for post-surgical follow-up are discussed. Keywords Morbid obesity . Laparoscopic sleeve gastrectomy . Portal vein thrombosis . Heterozygote Leiden 2 factor
Introduction Almost 25% of the population in developed countries suffers from obesity. Morbid obesity, defined by a body mass index over 40 kg/m2, is a major public health problem in the USA B. Berthet : E. Bollon : M. Ouaissi : I. Sielezneff : B. Sastre Digestive Surgical Department, CHU Timone, 264 rue Saint Pierre, 13385 Marseille, France R. Valero Nutrition Metabolic Diseases, Endocrinology Department, CHU Timone, 264 rue Saint Pierre 13385, Marseille, France B. Berthet (*) Department of Digestive Surgery, CHU Timone, 164 rue Saint Pierre, 13364 Marseille, France e-mail: [email protected]
[1]. More than one third of adults seem to be the ones concerned. Surgery appears to be the most efficient and costeffective method of treatment for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is the latest technical improvement in the field of bariatric surgery. It has rapidly gained an important place amongst the surgical procedures [2–4]. Nevertheless, this procedure is not entirely free of surgical complications [5]. We report a case of portal vein thrombosis, bound to genetic disorders of the prothrombin gene, which occurred in the post-operative course of an LSG performed to treat morbid obesity.
Case Report A 42-year-old woman with morbid obesity was referred to our department. She received an oestro-progestative contraceptive treatment and had a tobacco intoxication (13 packs per year). Because of her obesity (body mass index (BMI)=43.9 kg/m2), she had previously benefited of a gastric banding in 1999 in another hospital. No medical details could be collected on the post-operative course of this procedure except the patient's comments about an uneventful recovery. A gastric binding dysfunction occurred and led to its withdrawal in 2006 whereas her BMI was 29 kg/m2. The patient regained her former weight and consulted our bariatric surgical unit on March 2008 in the hope of a new surgical treatment for her obesity. After a sharp medical and surgical evaluation, a new surgical approach was decided and an LSG was lapa
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