Acute Pulmonary Thromboembolism Following Gastroenterological Surgery

Shigeo Hisamori, Ryo Matsusue, Yuki Masano*, Iku Tsukinuki*, Masaaki Awane*, Tsunehiro Yoshimura*, Satoru Nishimura*, Yoshinori Nakamura* and Satoru Matsusue*

Department of Gastroenterological Surgery, Kyoto University
Department of Abdominal and General Surgery, Tenriyorozusoudanjyo Hospital*

Introduction: Pulmonary thromboembolism (PTE) is one of the most important postoperative complications affecting in-patient prognosis. Methods: We clinically reviewed 19 cases from January 2000 to June 2007 in which acute PTE developed following gastroenterological surgery. Results: Subjects were 3 men and 16 women accounting for 0.30% of all surgically treated patients during this period. Their average age was 68.8±10.6 years and average body mass index (BMI) 24.0±2.5. Malignancy was involved in 15 cases and cholelithiasis in 4. Acute PTE is strongly indicated when symptoms of dyspnea, chest discomfort, and acute circulatory insufficiency are observed toward the end of recovery, hypoxemia and hypocapnia are detected in blood gas analysis, and right ventricular dilatation is seen in echocardiography. Thoracic contrast-enhanced computed tomography (CT) is one of the most reliable method of diagnosing PTE, with thrombi recognized in 16 of our 19 cases. We conducted anticoagulant therapy using low-dose unfractionated heparin in most cases and thrombolytic therapy using urokinase in 3 cases immediately after diagnosis, saving all patients. Anticoagulant warfarin therapy has prevented further embolic disease in all 19. Conclusion: Our clinical data shows a better prognosis in PTE patients than in previous reports, due, we concluded, to mechanical prophylaxis using graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) and early diagnosis. PTE is the most critical complication following gastrointestinal surgery, so more pharmacological prophylaxis such as low-dose unfractionated heparin may be necessary in those at high risk for PTE. The potential development of PTE must therefore be borne in mind if circulatory insufficiencies are observed in postoperative patients toward the end of recovery.

Key words
pulmonary thromboembolism, gastroenterological surgery, postoperative complication, mechanical and pharmacologic prophylaxis

Reprint requests
Shigeo Hisamori Department of Gastroenterological Surgery, Kyoto University
54 Shougoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
September 26, 2007

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