ISQUEMIA MESENTÉRICA DEBIDA A TROMBOSIS PORTOMESENTÉRICA TRAS MANGA GÁSTRICA: REPORTE DE CASO Y REVISIÓN DE LA LITERATURA
DOI:
https://doi.org/10.56238/arev7n10-087Palabras clave:
Obesidad, Isquemia Mesentérica, Evento Tromboembólico, Manga GástricaResumen
La obesidad es un importante problema de salud pública en Brasil, con una prevalencia creciente y se proyecta que alcance a un tercio de la población adulta para 2030. La gastrectomía vertical (manga gástrica) se destaca como una técnica bariátrica eficaz para la pérdida de peso y el control de la comorbilidad, con una menor tasa de complicaciones en comparación con otros procedimientos. Sin embargo, pueden ocurrir eventos adversos graves, como la trombosis portomesentérica (TVPM) y la isquemia mesentérica aguda (IAM), aunque poco frecuentes, y se asocian con una alta mortalidad. Presentamos el caso de un paciente de 43 años con obesidad grado III sometido a una gastrectomía vertical electiva que desarrolló trombosis de la vena porta y de la vena mesentérica superior el día 21 del postoperatorio, seguida de isquemia intestinal extensa y fallecimiento. Este caso resalta la necesidad de una vigilancia clínica intensiva y el diagnóstico precoz de complicaciones tromboembólicas en el postoperatorio de la cirugía bariátrica, dados sus desenlaces potencialmente fatales.
Descargas
Referencias
Kodaira K, Abe FC, Galvão TF, Silva MT. Time-trend in excess weight in Brazilian adults: A systematic review and meta-analysis. PLoS One. 2021 Sep 28;16(9):e0257755. doi: 10.1371/journal.pone.0257755. PMID: 34582470; PMCID: PMC8478247.
Garcia CAB, Meira KC, Souza AH, Oliveira ALG, Guimarães NS. Obesity and Associated Factors in Brazilian Adults: Systematic Review and Meta-Analysis of Representative Studies. Int J Environ Res Public Health. 2024 Aug 2;21(8):1022. doi: 10.3390/ijerph21081022. PMID: 39200634; PMCID: PMC11354148.
de Medeiros JM, Silva-Neto LGR, Dos Santos TLF, Dos Santos Neto JE, de Menezes Toledo Florêncio TM. Higher consumption of ultra-processed foods is associated with obesity and abdominal obesity in socially vulnerable Brazilian women. Nutr Bull. 2024 Jun;49(2):199-208. doi: 10.1111/nbu.12675. Epub 2024 Apr 16. PMID: 38623590.
Lager CJ, Esfandiari NH, Luo Y, Subauste AR, Kraftson AT, Brown MB, Varban OA, Meral R, Cassidy RB, Nay CK, Lockwood AL, Bellers D, Buda CM, Oral EA. Metabolic Parameters, Weight Loss, and Comorbidities 4 Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg. 2018 Nov;28(11):3415-3423. doi: 10.1007/s11695-018-3346-1. PMID: 29909517; PMCID: PMC8933864.
McCarty TR, Jirapinyo P, Thompson CC. Effect of Sleeve Gastrectomy on Ghrelin, GLP-1, PYY, and GIP Gut Hormones: A Systematic Review and Meta-analysis. Ann Surg. 2020 Jul;272(1):72-80. doi: 10.1097/SLA.0000000000003614. PMID: 31592891.
Leanza S, Coco D, Viola MG. Sleeve Gastrectomy: Literature Results. Maedica (Bucur). 2024 Mar;19(1):137-146. doi: 10.26574/maedica.2024.19.1.137. PMID: 38736914; PMCID: PMC11079741.
Howard R, Chao GF, Yang J, Thumma J, Chhabra K, Arterburn DE, Ryan A, Telem DA, Dimick JB. Comparative Safety of Sleeve Gastrectomy and Gastric Bypass Up to 5 Years After Surgery in Patients With Severe Obesity. JAMA Surg. 2021 Dec 1;156(12):1160-1169. doi: 10.1001/jamasurg.2021.4981. PMID: 34613354; PMCID: PMC8495604.
Kermansaravi M, Vitiello A, Valizadeh R, Shahmiri SS, Musella M. Comparing the safety and efficacy of sleeve gastrectomy versus Roux-en-Y gastric bypass in elderly (>60 years) with severe obesity: an umbrella systematic review and meta-analysis. Int J Surg. 2023 Nov 1;109(11):3541-3554. doi: 10.1097/JS9.0000000000000629. PMID: 37800553; PMCID: PMC10651291.
Nie Y, Tian Z, Wang P, Liu B, Zhang N, Zhou B, Wang S, Hei X, Meng H. Prevalence of anemia and related nutrient deficiencies after sleeve gastrectomy: A systematic review and meta-analysis. Obes Rev. 2023 Jan;24(1):e13516. doi: 10.1111/obr.13516. Epub 2022 Nov 2. PMID: 36323610.
Gipe J, Agathis AZ, Nguyen SQ. Managing Leaks and Fistulas After Laparoscopic Sleeve Gastrectomy: Challenges and Solutions. Clin Exp Gastroenterol. 2025 Jan 7;18:1-9. doi: 10.2147/CEG.S461534. PMID: 39802341; PMCID: PMC11724628.
Iannelli A, Treacy P, Sebastianelli L, Schiavo L, Martini F. Perioperative complications of sleeve gastrectomy: Review of the literature. J Minim Access Surg. 2019 Jan-Mar;15(1):1-7. doi: 10.4103/jmas.JMAS_271_17. PMID: 29737316; PMCID: PMC6293679.
Huerta C, Rivero E, Montoro MA, Garcia-Rodriguez LA. Fatores de risco para isquemia intestinal entre pacientes registrados em um banco de dados de cuidados primários do Reino Unido: um estudo de caso-controle aninhado. Aliment Pharmacol Ther. 2011; 33(8):969–78.
Acosta S. Epidemiologia da doença vascular mesentérica: implicações clínicas. Semin Vasc Surg. 2010; 23(1):4–8.
Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, et al. Isquemia mesentérica aguda: diretrizes atualizadas da sociedade mundial de cirurgia de emergência. Mundo J Emerg Surg. 2022; 17(1):54.
Ma T, Zhao H, Zhang Q, Zhang P. Trombose da veia mesentérica após gastrectomia vertical: relato de caso e revisão da literatura. Fatos sobre Obes. 2024; 17(2):211-216. DOI: 10.1159/000536359. Epub 2024 19 de janeiro. PMID: 38246162; PMCID: PMC10987191.
Chao GF, Montgomery JR, Abou Azar S, Telem DA. Venous thromboembolism: risk factors in the sleeve gastrectomy era. Surg Obes Relat Dis. 2021 Nov;17(11):1905-1911. doi: 10.1016/j.soard.2021.06.022. Epub 2021 Jul 8. PMID: 34389247.
Ali H, Inayat F, Moond V, Chaudhry A, Afzal A, Anjum Z, Tahir H, Anwar MS, Dahiya DS, Afzal MS, Nawaz G, Sohail AH, Aziz M. Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning. World J Gastrointest Surg. 2024 Apr 27;16(4):1097-1108. doi: 10.4240/wjgs.v16.i4.1097. PMID: 38690043; PMCID: PMC11056662.
Lomeli-Reyes D, Martinez-Esteban A, Barron-Cervantes NM, Peña S, Torres Villalobos G, G Gidi AD. Optimal Thromboprophylaxis in Laparoscopic Bariatric Surgery in a Private Third-Level Center in Mexico City. Cureus. 2025 Jun 23;17(6):e86593. doi: 10.7759/cureus.86593. PMID: 40704261; PMCID: PMC12285611.
Belluzzi, A., Sample, J. W., Marrero, K., Tomey, D., Puvvadi, S., Sharma, I., & Ghanem, O. M. (2024). Rare Complications Following Laparoscopic Sleeve Gastrectomy. Journal of Clinical Medicine, 13(15), 4456. https://doi.org/10.3390/jcm13154456
Gomes R, Costa-Pinho A, Ramalho-Vasconcelos F, Sousa-Pinto B, Santos-Sousa H, Resende F, Preto J, Lima-da-Costa E, Cri-O Group. Portomesenteric Venous Thrombosis after Bariatric Surgery: A Case Series and Systematic Review Comparing LSG and LRYGB. J Pers Med. 2024 Jul 4;14(7):722. doi: 10.3390/jpm14070722. PMID: 39063976; PMCID: PMC11277930.
Şen O, Kara S, Türkçapar AG. Porto-mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. A case report. Int J Surg Case Rep. 2021 Feb;79:424-427. doi: 10.1016/j.ijscr.2021.01.086. Epub 2021 Jan 26. PMID: 33524799; PMCID: PMC7851411.
Stancu B, Chira A, Coman HF, Mihaileanu FV, Ciocan R, Gherman CD, Andercou OA. Intestinal Obstruction as Initial Presentation of Idiopathic Portal and Mesenteric Venous Thrombosis: Diagnosis, Management, and Literature Review. Diagnostics (Basel). 2024 Jan 30;14(3):304. doi: 10.3390/diagnostics14030304. PMID: 38337820; PMCID: PMC10855345.
Tamme K, Reintam Blaser A, Laisaar KT, Mändul M, Kals J, Forbes A, Kiss O, Acosta S, Bjørck M, Starkopf J. Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis. BMJ Open. 2022 Oct 25;12(10):e062846. doi: 10.1136/bmjopen-2022-062846. PMID: 36283747; PMCID: PMC9608543.
Alsannaa F, Albaqami F, Shalhoub M. Portomesenteric venous thrombosis in a prophylactically anticoagulated obese patient after laparoscopic sleeve gastrectomy: a case report. J Med Case Rep. 2021 Dec 17;15(1):623. doi: 10.1186/s13256-021-03174-w. PMID: 34920760; PMCID: PMC8684121.
Darcy DG, Charafeddine AH, Choi J, Camacho D. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy. Case Rep Surg. 2015;2015:705610. doi: 10.1155/2015/705610. Epub 2015 Oct 21. PMID: 26576312; PMCID: PMC4631877.
L R La Rosa et al. Venous thrombosis and obesity: from clinical needs to therapeutic challenges. Internal and Emergency Medicine, 2024.
Diretrizes da American Society of Hematology (ASH) 2019.
