Postoperative mesenteric venous thrombosis: Potential complication related to minimal access surgery in a patient with undiagnosed hypercoagulability

CONTEXT: Mesenteric venous thrombosis is a rare but potentially fatal complication associated with laparoscopy which has now become common practice and gold standard for many procedures in general surgery. There are only few scattered case reports in the literature describing this postoperative thrombotic event. CASE REPORT: In the present study, we describe a patient presenting with severe abdominal pain at 25 days following an uneventful laparoscopic paraesophageal hernia (PEH) repair and nissen fundoplication. Exploratory laparotomy revealed an extensive small bowel ischemia requiring bowel resection followed by a second look laparotomy. Retrospectively performed hematologic workup revealed a genetic mutation associated with hyperhomocysteinemia in addition to her hyperfibrinogenemia. Previously published data were collected and discussed. CONCLUSIONS: Mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic surgery especially in patients with underlying hypercoagulability. High index of suspicion is important in early diagnosis and subsequent treatment.