Bariatrik Cerrahide Sleeve Gastrektomi Sonrası Portal Ven Trombozu: Bir Olgu Sunumu
Özet
Sleeve gastrektomi sonrası postoperatif 12. gününde karın ağrısı, bulantı, hematemez ve hematokezya şikayeti ile acil servise başvuran hastaya yapılan abdominal BT anjiografi ile Porto-Mesenterik Venöz Trombozu (PMVT) tanısı konuldu. Hemodinamik olarak stabil olmayan hastaya yoğun bakımda antikoagülasyon tedavi başlandı. Septik şok ekarte edilemediğinden sıvı resüsitasyonu ve antibiyoterapi uygulandı. Hasta obez ve tromboz eğilimli olduğu için trombofili açısından ileri tetkik edildi. Klinik ve laboratuvar bulguları normale dönen hasta servis transferinden sonra evine taburcu edildi. Taburculuğun 10. gününde şiddetli karın ağrısı, bulantı ve kusma şikayetiyle acil servise başvuran hastaya abdominal BT görüntüleme yapıldı ve batında serbest hava gözlendi. Acil laporotomi uygulanan hastada barsak perforasyonu ve batın içinde intestinal içerik tespit edildi, barsak rezeksiyonu yapıldı. Ancak hastada sleeve gastrektomi sonrası postoperatif 1. ayında intestinal enfarkt ve barsak perforasyonu nedeniyle exitus gelişti. Hasta kaybedildikten sonra bildirilen trombofili panelinde heterozigot Faktör V Leiden mutasyonu beraberinde heterozigot Plasminogen Aktivatör İnhibitörü-1 polimorfizmi saptandı. Bu vaka obezite gibi yüksek riskli bir grupta trombofili eğilimini araştırmak ve tedavi seçeneklerini tartışmak için planlandı.
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