# Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery

## TL;DR

A rare case of severe portal hypertension after bariatric surgery was successfully treated with a splenorenal shunt and splenectomy.

## Contribution

This case report adds to the limited evidence on managing portal hypertension caused by post-bariatric surgery portal thrombosis.

## Key findings

- Portal thrombosis after sleeve gastrectomy can lead to severe portal hypertension and cavernomatosis.
- A proximal splenorenal shunt and splenectomy effectively managed the patient's complications.
- This case highlights the rare but possible long-term complications of bariatric surgery.

## Abstract

Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication. We present the case of a 33-year-old female patient who had previously undergone laparoscopic sleeve gastrectomy in 2014 and subsequently developed portal thrombosis, followed by cavernomatosis and associated complications of portal hypertension. A proximal splenorenal shunt procedure and splenectomy were successfully performed to manage portal hypertension. The presentation of this clinical case aims to contribute to the available evidence and knowledge surrounding this rare and challenging pathology.