{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:08:27Z","timestamp":1779170907220,"version":"3.51.4"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Mesenteric venous thrombosis (MVT) is an uncommon but potentially fatal complication following major hepatic resection. We report the case of a 62-year-old cirrhotic male with Hepatitis B who underwent an open right hemihepatectomy with Roux-en-Y reconstruction for a suspected Bismuth-Corlette Type 3A Klatskin tumour. On postoperative day (POD) 4, he developed refractory metabolic acidosis with profound hyperlactatemia, prompting urgent CT imaging and exploratory laparotomy which revealed extensive patchy small bowel ischaemia consistent with MVT. Serial laparotomies demonstrated relentless progression to total intestinal infarction despite maximal surgical and intensive care intervention and the patient succumbed to septic shock and multi-organ failure on POD 14. This case illustrates how the convergence of Virchow's triad in the post-hepatectomy cirrhotic patient, namely portal stasis exacerbated by inadequate fluid resuscitation, cirrhosis-mediated hypercoagulability and surgical endothelial injury can precipitate a rapidly fatal thrombotic cascade. It further highlights the dual clinical dilemma of diagnostic elusiveness as early imaging may be falsely negative and therapeutic paralysis where the perceived haemorrhagic risk of anticoagulation in a coagulopathic patient may delay the only intervention capable of halting thrombus propagation. This case underscores the imperative for heightened clinical vigilance, proactive hydration and a low threshold for repeat vascular imaging in cirrhotic patients undergoing major hepatectomy. Early anticoagulation tailored to the individual patient's risk profile should be carefully considered upon clinical suspicion of MVT, even in the setting of apparent coagulopathy.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1830475","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:39:27Z","timestamp":1779169167000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Fatal mesenteric venous thrombosis and progressive bowel ischemia following right hemihepatectomy"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhun Shen","family":"Tan","sequence":"first","affiliation":[{"name":"Faculty of Medicine, National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elvin Jia Hong","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rou Bei","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azlanudin","family":"Azman","sequence":"additional","affiliation":[{"name":"Hepatobiliary & Pancreatic Surgery Unit, Department of Surgery, Faculty of Medicine, National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Chik","sequence":"additional","affiliation":[{"name":"Hepatobiliary & Pancreatic Surgery Unit, Department of Surgery, Faculty of Medicine, National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.21037\/hbsn-19-948","article-title":"Short- and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma: does left or right side matter?","volume":"10","author":"Franken","year":"2021","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.bpg.2016.11.002","article-title":"Testing for thrombophilia in mesenteric venous thrombosis - retrospective original study and systematic review","volume":"31","author":"Zarrouk","year":"2017","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/j.amjsurg.2014.11.021","article-title":"Incidence, risk factors, and management options for portal vein thrombosis after hepatectomy: a 14-year, single-center experience","volume":"210","author":"Kuboki","year":"2015","journal-title":"Am J Surg"},{"key":"B4","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/978-1-4939-2223-9_25","article-title":"Postoperative portal, mesenteric, and splenic vein thrombosis.","volume-title":"Gastrointestinal Surgery","author":"Malleo","year":"2015"},{"key":"B5","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1067\/mva.2001.116965","article-title":"Mesenteric venous thrombosis: a changing clinical entity","volume":"34","author":"Morasch","year":"2001","journal-title":"J Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1177\/1457496920969084","article-title":"Management of acute mesenteric venous thrombosis: a systematic review of contemporary studies","volume":"110","author":"Acosta","year":"2021","journal-title":"Scand J Surg"},{"key":"B7","volume-title":"Virchow Triad","author":"Kushner","year":"2024"},{"key":"B8","doi-asserted-by":"publisher","first-page":"238","DOI":"10.3978\/j.issn.2304-3881.2014.09.01","article-title":"Post-hepatectomy liver failure","volume":"3","author":"Kauffmann","year":"2014","journal-title":"Hepatobiliary Surg Nutr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"100120","DOI":"10.1016\/j.jhepr.2020.100120","article-title":"Biomarkers of liver dysfunction correlate with a prothrombotic and not with a prohaemorrhagic profile in patients with cirrhosis","volume":"2","author":"Zermatten","year":"2020","journal-title":"JHEP Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/JP9.0000000000000051","article-title":"A systematic review of the management of acute superior mesenteric vein thrombosis in adults","volume":"3","author":"Phoenix","year":"2020","journal-title":"J Pancreatol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1830475\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:39:29Z","timestamp":1779169169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1830475\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":10,"alternative-id":["10.3389\/fsurg.2026.1830475"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1830475","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"1830475"}}