Fatal pulmonary embolism after surgery for small intestinal necrosis caused by idiopathic portal vein thrombosis: a case report

TL;DR

A 69-year-old woman with idiopathic portal vein thrombosis developed fatal pulmonary embolism after surgery for small intestinal necrosis.

Contribution

This case report highlights the rare but severe complication of pulmonary embolism following idiopathic portal vein thrombosis.

Findings

The patient developed pulmonary embolism after surgery for small intestinal necrosis caused by idiopathic portal vein thrombosis.

Prompt intervention with extracorporeal resuscitation and anticoagulation led to recovery without neurological damage.

Abstract

Portal vein thrombosis (PVT) and venous thromboembolism (VTE) both result from partial or complete occlusion of a blood vessel by a blood clot. The prognosis of PVT is generally good; however, PVT with VTE, including pulmonary embolism (PE), has a high mortality rate. We report here a case of PE after surgery for small intestinal necrosis caused by idiopathic PVT.

A 69-year-old female attended our hospital with a chief complaint of upper abdominal discomfort, and was diagnosed with necrosis of the small intestine as a result of unexplained PVT. She underwent partial resection of the small intestine. On the second postoperative day, she suffered from respiratory distress and went into cardiopulmonary arrest. The patient recovered following cardiopulmonary resuscitation, but PE was detected. Extracorporeal veno-arterial cardiopulmonary resuscitation and anticoagulation therapy were initiated immediately and the thrombus was aspirated as much as possible. Two days later, extracorporeal veno-arterial cardiopulmonary resuscitation was withdrawn and anticoagulation therapy was continued. The patient subsequently recovered with no neurological damage and was discharged on day 26 after the above procedure.

Idiopathic PVT is often associated with VTE, and a prompt diagnosis and intervention may result in a good prognosis.

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