Acute Pulmonary Embolism Following Gastroenterological Surgery

Toshiyuki Arai, Kitao Hachisuka, Akihiro Yamaguchi, Masatoshi Isogai, Akihiro Hori, Keiya Aono, Naoharu Mori, Atsuyuki Maeda, Masami Kawai, Manabu Takano, Ryuzo Yamaguchi

Department of Surgery, Ogaki Municipal Hospital

Eight cases in which acute pulmonary embolism (PE) developed during the past ten years following gastroenterological surgery were clinically reviewed. These cases represented 0.07% of all surgically treated patients for the same period. The average age of these patients was 65.5 years (55-73), including one man and seven women. There were seven cases of malignacy and one case of cholelithiasis. Acute PE is strongly suspected if symptoms of dyspnea, chest pain, chest discomfort and acute circulatory insufficiency are observed towards the end of the recuperative period and if right ventricular dilatation is demonstrated by subsequent echocardiogram. Pulmonary arteriography is the most reliable method of diagnosing PE, as thrombi were recognized in all of the five cases examined. Five of eight patients survived following thrombolytic and anticoagulant therapy, but three patients died. Two of those three patients died within a few hours following the onset, but the other patient survived for 11 days by means of thrombolytic and anticoagulant therapy combined with a cardiopulmonary partial bypass procedure. Thromblytic and anticoagulant therapy are recommended as initial treatment for acute PE in addition to controlling circulation by employing a partial cardiopulmonary bypass procedure as circumstances demand.

Key words
acute pulmonary embolism, postoperative complication, thrombolytic and anticoagulant therapy, digital subtraction angiography

Reprint requests
Toshiyuki Arai Department of Surgery, Ogaki Municipal Hospital
48-6 Minaminokawa-machi, Ogaki, 503 JAPAN

Accepted
May 11, 1994

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