Report of Five Cases of Acute Pulmonary Embolism after Gastrointestinal Surgery

Youichi Hamai, Minoru Tanada, Kenjiro Aogi, Masahiro Ishizaki, Yoshiro Kubo, Shozo Ohsumi, Akira Kurita, Hideyuki Saeki and Shigemitu Takashima

Department of Surgery, National Shikoku Cancer Center

The incidence of pulmonary embolism (PE) has been increasing, although it considered lower in Japan than in the West. We report 5 cases of PE after gastrointestinal surgery from January 1994 to March 2001 representing 0.2% of surgically treated patients during that period. In 4 cases except a light PE patient, it occurred when they first walked after surgery. 1 case of PE occurred despite using intermittent pneumatic compression (IPC) during surgery to prevent it. We diagnosed PE by pulmonary perfusion scintigraphy or thoracic computed tomography (CT). We conducted anticoagulant therapy using heparin and thrombolytic therapy using urokinase or tissue plasminogen activator (t-PA) immediately after the diagnosis. We could save 3 patients, including 1 with light PE and 2 treated by t-PA. Serious complications in thrombolytic therapy occurred in 3 (2 massive bleedings and 1 extensive cerebral hemorrhage). PE is the most critical complication after gastrointestinal surgery, so more prevention as low-dose unfractionated heparin or elastic stockings may be necessary in high risk group of PE.

Key words
postoperative pulmonary embolism, prevention, diagnosis and treatment of PE

Reprint requests
Youichi Hamai Department of Surgery, National Shikoku Cancer Center 13 Horinouchi, Matuyama, 790-0007 JAPAN

Accepted
October 30, 2002

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