**4.6 Portomesenteric venous thrombosis**

Portomesenteric venous thrombosis is a rare complication of LSG thought to be secondary to regional postsurgical inflammation, change in venous outflow, and dehydration predisposing to clot formation [72]. Patients may present 1–2 weeks after surgery with vague abdominal pain, severe nausea and vomiting, fever and diffuse abdominal tenderness. Diagnosis is confirmed with CT scan. Treatment consists of anticoagulation, fluid resuscitation, and bowel rest. Thrombolytics may be indicated depending on severity of symptoms. There are no established guidelines for the duration of anticoagulation therapy, but patients are usually treated for 3–6 months. Surgical treatment is reserved for patients with evidence of infarcted bowel [84].
