A Operative Case Report of Duodenal Ulcer Perforation with Polycythemia Vera Complicated Postoperative Acute Respiratory Distress Syndrome

Hidetaka Yamanaka, Takahiko Ishizaka, Satoru Kawai, Hiroyuki Matsunaga, Yasushi Kitoh, Satoaki Kamiya and Yasutaka Matsuzaki

Department of Surgery, Tsusima City Hospital

Perioperative surgical management in patients with polycythemia vera (PV) is important. We report a case of duodenal ulcer perforation requiring emergency surgery. A 56-year-old man diagnosed with PV at age 25 and undergoing medication but who intermissioned himself at age 36 and later admitted for postprandial abdominal pain was found in abdominal computed tomography and gastrointestinal endoscopy to have peritonitis caused by duodenal ulcer perforation, necessitating emergency omental patch surgery. He suffered postoperative complication of acute respiratory distress syndrome (ARDS) but no bleeding or thrombosis. His condition improved after intensive care involving endotracheal intubation and respiratory control and continuous infusion of sivelestat sodium, and he discharged on postoperative day 24. Perioperative management for PV patients must take into account the possibility of pulmonary complication, bleeding, and thrombosis because of the constant activation of neutrophils and increased elastase release, that make pre-ARDS status.

Key words
polycythemia vera, surgery, acute respiratory distress syndrome

Reprint requests
Hidetaka Yamanaka Department of Surgery, Tsushima City Hospital
3-73 Tachibana-cho, Tsushima, 496-8537 JAPAN

Accepted
May 21, 2008

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