Massive pulmonary embolism and intra-cardiac thrombus requiring systemic thrombolysis 9-hours post emergency laparotomy.
Andrew Stafford BeattyFraser Hugh SimpsonManju D ChandrasegaramPublished in: Journal of surgical case reports (2022)
The link between abdominal surgery and venous thromboembolism (VTE) has been well established with recent evidence exploring the optimal VTE risk reducing strategy. However, despite these strategies pulmonary embolisms (PEs) do occur, which in the immediate post-operative setting creates a dilemma; to treat the VTE with anticoagulation but balance against the risk of hemorrhage. Treatment guidelines often do not include post-operative patients leaving the decision up to the treating physician to weigh the relative risks on an individual basis. We present a 59-year-old lady who developed a life-threatening submassive PE within 9 h of an emergency laparotomy for a perforated rectal cancer. She was treated with systemic thrombolysis after alternative interventions had been excluded. She responded well to therapy with no major bleeding. She was successfully discharged home after a short period of inpatient rehabilitation.
Keyphrases
- pulmonary embolism
- venous thromboembolism
- direct oral anticoagulants
- inferior vena cava
- emergency department
- end stage renal disease
- rectal cancer
- healthcare
- newly diagnosed
- public health
- chronic kidney disease
- ejection fraction
- primary care
- pulmonary hypertension
- peritoneal dialysis
- atrial fibrillation
- palliative care
- mental health
- left ventricular
- stem cells
- radiation therapy
- emergency medical
- mesenchymal stem cells
- acute care