Since the first reported case in 1994, a small but significant number of patients have developed major mesenteric arterial and venous thromboses after laparoscopy, usually with catastrophic outcomes. The basic science data in both animal and human models suggest that these events were due in part to specific predisposing patient factors, combined with the physiologic changes in splanchnic hemodynamics that occur during induction and maintenance of pneumoperitoneum. The following manuscript examines the science of this phenomenon in detail and the features of the reported cases to date, with the goal being to increase awareness of this serious and likely underreported phenomenon.
Get full access to this article
View all access options for this article.
References
1.
PhillipsK., HulkaJ., PetersonH.American association of gynecologic laparoscopist's 1982 membership survey.J Reprod Med1984; 29: 592–4.
MillikanK., SzczerbaS., DominguezJ.Superior mesenteric and portal vein thrombosis following laparoscopic assisted right hemicolectomy: Report of a case.Dis Colon Rectum1996; 39: 1171–5.
17.
KlugewitzK., RehermannB., SeifertU.A rare case of bloody diarrhea: thrombosis of the V. mesenterica inferior following laparoscopic cholecystectomy.Z Gastroenterol1998; 36: 35–9.
18.
KenppainenE., KokkolaA., SirenJ., KiviloutoT.Superior mesenteric and portal vein thrombosis following laparoscopic Nissen fundoplication.Dig Surg2000; 17: 279–81.
19.
BaixauliJ., DelaneyC., SenagoreA.Portal vein thrombosis after laparoscopic sigmoid colectomy for diverticulitis: Report of a case.Dis Colon Rectum2003; 46: 550–3.
JohnsonC., de la TorreR., ScottS., JohansenT.Mesenteric venous thrombosis after laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis2005; 1: 580–3.
25.
PoultsidesG., LewisW., FeldR.Portal vein thrombosis after laparoscopic colectomy: Thrombolytic therapy via the superior mesenteric vein.Am Surg2005; 71: 856–60.
26.
AbdelrazeqA., DwaikM., AldooriM.Laparoscopy associated portal vein thrombosis: Description of an evolving clinical syndrome.J Laparoendosc Adv Surg Tech A1997; 16: 9–14.
27.
LamL., AcostaJ.Abdominal pain after uncomplicated laparoscopic appendectomy.J Am Coll Surg2007; 204: 177–8.
28.
CaldwellC., RicottaJ.Changes in visceral blood flow with elevated intraabdominal pressure.J Surg Res1987; 43: 14–20.
29.
IshizakiY., BandaiY., ShimomuraK.Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide.Surg Endosc1993; 7: 420–3.
30.
OrtegaA., RichmanM., HernandezM.Inferior vena caval blood flow and cardiac hemodynamics during carbon dioxide pneumoperitoneum.Surg Endosc1996; 10: 920–4.
31.
JakimowiczJ., StultiensG., SmuldersF.Laparoscopic insufflation of the abdomen reduces portal venous flow.Surg Endosc1998; 12: 129–32.
32.
SchillingM., RedaelliC., KrahenbuhlL.Splanchnic microcirculatory changes during CO2 laparoscopy.J Am Coll Surg1997; 184: 378–82.
33.
AlfonsiP., Viellard-BaronA., CoggiaM.Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: A transesophageal echocardiographic study.Anesth Analg2006; 102: 1304–10.
34.
KotzampassiK., KapanididisN., KazamiasP., EleftheriadisE.Hemodynamic events in the peritoneal environment during pneumoperitoneum in dogs.Surg Endosc1993; 7: 494–9.
35.
WindsorJ., BonghamM., RumballM.Splanchnic mucosal ischemia: An unrecognized complication of pneumoperitoneum.Surg Laparosc Endosc1997; 7: 480–2.
36.
JunghansT., BohmB., GrundelK.Does pneumoperitoneum with different gases, body positions and intraperitoneal pressures influence renal and hepatic blood flow?Surgery1997; 121: 206–11.
37.
IbraheimO., SamarkandiA., AlshehryH.Lactate and acid base changes during laparoscopic cholecystectomy.M E J Anesth2006; 18: 757–67.
38.
EpsteinR., WheelerH., FruminJ.The effect of hypercapnia on estimated hepatic blood flow, circulating splanchnic blood volume, and hepatic sulfobromophthalein clearance during general anesthesia in man.J Clin Invest1961; 40: 592–8.
39.
MarshallR., JebsonP., DavieI., ScottD.Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy.Br J Anaesth1972; 44: 680–4.
40.
MarshallN., BessellJ., MaddernG.Study of venous blood flow changes during laparoscopic surgery using a thermodilution technique.Aust N Z J Surg2000; 70: 639–43.
41.
CapriniJ., ArcelusJ., LaubachG.Postoperative hypercoagulability and deep vein thrombosis after laparoscopic cholecystectomy.Surg Endosc1995; 9: 304–9.
42.
EguchiA., HashizumaM., KitanoS.High rate of portal thrombosis after splenectomy in patients with esophageal varices and idiopathic portal hypertension.Arch Surg1991; 126: 752–5.
43.
StamouK., ToutouzasK., KekisP.Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric and splenic veins.Arch Surg2006; 141: 663–9.
