A Case of Pulmonary Thromboembolism after Laparoscopy-assisted Colectomy

Fumitaka Nakamura, Mitsuru Dohke, Tohru Nakamura, Kyosuke Miyazaki, Tosiaki Shitinohe, Yoshiaki Narita, Tomosige Masuda, Nobuichi Kasimura, Osamu Matunami and ^*Hiroyuki Katoh

Department of Surgery, Institute of Gastroenterology, Teine Keijinkai Hospital
^*Second Department of Surgery, Hokkaido University School of Medicine

We experienced a case of thromboembolism after laparoscopy-assisted colectomy. A 67-year-old man underwent laparoscopy-assisted descending colon resection with lymph node dissection for early colon cancer. During the laparoscopic procedures, the intraabdominal pressure was set at 10 to 12 mmHg by peritoneal insufflation of CO₂ while the patient kept a slight head-up tilt position, and the operative time was 270 minutes. The postoperative course was uneventful until the 7th postoperative day. Suddenly he complained of a chest pain when he was getting out of bed. A pulmonary perfusion sintigram revealed a segmental perfusion defect of the left S5 area. He was diagnosed as having a pulmonary thromboembolism, and anticoagulant therapy with heparin was initiated. After the therapy, his condition improved. Only 6 cases of pulmonary thromboembolism after laparoscopic gastroenterological surgery have been reported in the Japanese literature up to now, and there have been only 2 cases after laparoscopic colectomy. This case represents 0.11% of 880 laparoscopic surgically treated patients in our institute. Although pulmonary thromboembolism is very rare, it should be considered as one of the most critical complication after laparoscopic surgery, and we have to use careful control during and after surgery.

Key words
laparoscopy-assisted colectomy, postoperative complication, pulmonary thromboembolism

Reprint requests
Fumitaka Nakamura Department of Surgery, Institute of Gastroenterology, Teine Keijinkai Hospital 1-12-355 Maeda, Teine-ku, Sapporo, 006-8555 JAPAN

Accepted
November 13, 1998

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