Portal vein thrombosis: an unusual complication of laparoscopic cholecystectomy.

BACKGROUND: Complications following laparoscopic cholecystectomy are encountered infrequently due to increasing proficiency in laparoscopic surgery. The occurrence of portal venous thrombosis following laparoscopic cholecystectomy has not been previously described and forms the basis of this report. METHODS: A healthy, 32-year-old, female on oral contraceptives underwent an uneventful laparoscopic cholecystectomy for symptomatic gallbladder disease. Sequential compression devices and mini-dose unfractionated heparin were used before the procedure. The patient was discharged home on the first postoperative day without complaints. She returned 1 week later with nausea, bloating, and diffuse abdominal pain. RESULTS: Ultrasonography of the abdomen revealed thrombosis of the portal vein not seen in the preoperative ultrasound and the superior mesenteric vein. Computer tomography of the abdomen and pelvis on the same day confirmed this finding and showed a wedge-shaped infarction of the right lobe of the liver. The patient was anticoagulated with intravenous heparin. An extensive coagulation workup revealed elevation of the Immunoglobulin G anticardiolipin antibody. A percutaneous transhepatic portal vein thrombectomy was performed. A postprocedure duplex ultrasound of the abdomen demonstrated recannalization of the portal venous system with no flow voids. Anticoagulation therapy was continued, and the patient was discharged home with resolution of her ileus. She was maintained on a therapeutic dose of warfarin. CONCLUSIONS: This case demonstrates an unusual complication of laparoscopic cholecystectomy. It may have resulted from the use of oral contraceptives, elevation of the Immunoglobulin G anticardiolipin antibody, unrecognized trauma, and was accentuated by the pneumoperitoneum generated for the performance of the laparoscopic cholecystectomy. Our case report provides insight and poses questions regarding necessary perioperative measures for thromboprophylaxis in young females on oral contraceptives undergoing elective laparoscopic abdominal surgery.

Benefits of surgical experience in a third-world country during residency.

PURPOSE: Completion of a United States surgical residency enables the graduate to provide service in most populated areas. Graduates are technically well trained and efficient in performing most surgeries. United States-based teaching facilities are generally furnished with technically advanced supplies and equipment. Access to financial reserve is also available. Surgery in third-world countries, however, can be challenging. These countries, particularly in the outskirts, lack supplies and innovation, such as advanced equipment, medication, and personnel. Compounding the problem, patients tend to have advanced pathology and diminished financial means. METHODS: The United States-based surgical team annually collaborated with a medical mission to provide service to a rural community of the Dominican Republic. A senior-level surgery resident accompanied the surgeon. Surgical supplies were donated and brought with the team. The average number of cases performed was approximately 37 per week. All procedures were performed for symptomatic pathology. All patients were preoperatively screened and evaluated for comorbidities. RESULTS: No immediate complications occurred. Local physicians provide long-term follow-up. Pediatric procedures were not performed secondary to lack of postoperative resources. CONCLUSIONS: Surgical experience is beneficial to the recipient community and the resident surgeon. The extent of pathology and lack of resources enforces efficiency and broadens skills. This opportunity can potentially prepare surgeons for the growing need of rural surgery.