A Case of Acute Pulmonary Embolism in the Early Postoperative Day

Hajime Hikino, Masahisa Nakagawa

Department of Surgery, Shimane Prefectural Central Hospital

A 62-year-o1d man received total gastrectomy and cholecystectomy for early remnant gastric cancer and cholecystolithiasis on February 6, 1995. On the 2nd postoperative day, he had a sudden attack of loss of consciousness and general convulsion during bed rest. Despite marked arterial hypoxemia (PaO₂ 20 mmHg), chest radiography and ECG showed no apparent abnormalities. But chest-enhanced CT and pulmonary angiography revealed a large thrombus in the main trunk of the right pulmonary artery, and lung perfusion scintigraphy revealed multiple wedge-shaped defects especially in the right lung. Therefore we diagnosed this case as acute massive pulmonary embolism. Continuous infusion of urokinase and heparin through an indwelling catheter in the right pulmonary artery was instituted, followed by insertion of an inferior vena caval filter (IVCf) 2nd day after the onset, for the purpose of early ambulation and prevention of a recurrent pulmonary embolism. He had a good clinical course without complications, and was discharged on May 13. For postoperative pulmonary embolism, insertion of an IVCf in the early stage is considered to be beneficial for effective therapy and the prevention of a recurrent embolism, in addition to the conventional anticoagulant and thrombolytic therapy.

Key words
pulmonary embolism, inferior vena caval filter, postoperative complications

Reprint requests
Hajime Hikino Department of Surgery, Shimane Prefectural Central Hospital
116 Imaichi-machi, Izumo-city, 693 JAPAN

Accepted
January 10, 1996

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