A Surgical Case of Severe Ulcerative Colitis with Pulmonary Thromboembolism and Right Common Iliac Vein Thrombosis

Fumito Saijo, Yuji Funayama, Hiroo Naito, Kouhei Fukushima, Chikashi Shibata, Taku Kitayama, Seiki Matsuno^* and Iwao Sasaki

Department of Surgery, Division of Biological Regulation and Oncology, Gastroenterological Surgery^*, Tohoku University Graduate School of Medicine

A 19-year-old man with anal bleeding was diagnosed with ulcerative colitis in September 1999, and followed up and treated at another hospital. He was referred to us due to steroid resistance in March 2001. Thrombosis of the right iliac vein and lung was detected by abdominal computed tomography (CT) and lung scintigraphy. An inferior vena cava (IVC) filter was implanted and anticoagulant therapy started the day before surgery in prophylactic therapy for pulmonary thromboembolism. He underwent subtotal colectomy, ileostomy, and rectal mucous fistula. On postoperative day (POD) 8, thrombolytic therapy was restarted due to distal vein thrombus from the IVC. After removal of the IVC filter, warfarin was administered and his postoperative course was uneventful. It is thus important to consider venous thrombosis complications in surgical treatment of inflammatory bowel disease, which requires anticoagulant therapy and prophylactic management.

Key words
ulcerative colitis, deep vein thrombosis, pulmonary thromboembolism

Reprint requests
Fumito Saijo Department of Surgery, Division of Biological Regulation and Oncology, 1-1Seiryo-cho, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
January 30, 2002

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