LAPAROSCOPIC SURGERY AND SPLANCHNIC VESSEL THROMBOSIS

We report a case of fatal mesenteric artery thrombosis following lapar oscopic cholecystectomy in a 60-year-old hypertensive woman, whose pre operative complaints were not typical of calculous biliary disease. Tw o previous case reports have associated laparoscopic cholecystectomy a nd acute intestinal ischemia; one of these patients died. Experimental and clinical data indicate that carbon dioxide pneumoperitoneum reduc es splanchnic blood flow through several mechanical and physiologic me chanisms. Consequently, we believe that, when laparoscopic surgery is contemplated, physicians and patients should be aware of the risk of s planchnic vessel thrombosis, especially when certain pre-existing cond itions are present (e.g., impairment of splanchnic vessel flow, hyperc oagulable states, etc.). For such high-risk patients, especially when the planned laparoscopic procedure may be lengthy, gasless or low-pres sure laparoscopic surgery, or even reversion to traditional open surge ry should be considered.