# Intraoperative Catastrophic Acute Pulmonary Embolism: A Case Report

## TL;DR

A 75-year-old woman with multiple health issues had a life-threatening pulmonary embolism during surgery, highlighting the risks in complex surgical cases.

## Contribution

This case report adds to the understanding of intraoperative catastrophic events in high-risk surgical patients.

## Key findings

- The patient developed pulseless ventricular tachycardia during surgery requiring resuscitation.
- Intraoperative findings included biventricular failure and a clot in the right pulmonary artery.
- Despite VA ECMO treatment, the patient's condition worsened, leading to withdrawal of life support.

## Abstract

This case report describes a 75-year-old female with a medical history including recurrent bowel obstruction due to sigmoid stricture, atrial fibrillation managed with rivaroxaban, a 50-year one pack-per-day smoking history, hypertension, hyperlipidemia, peripheral vascular disease with bilateral iliac stents (2015), stage III chronic kidney disease, and renal artery stenosis with bilateral stenting. She was transferred from outside hospital for an elective sigmoidectomy with ileorectal anastomosis following several recent admissions due to bowel obstruction that had been managed non-operatively. She was deemed optimized for surgery by the primary care team; however, during induction, she developed pulseless ventricular tachycardia requiring extensive resuscitative efforts. Intraoperative findings revealed biventricular failure and a clot in the right pulmonary artery. Despite aggressive treatment, including veno-arterial extracorporeal membrane oxygenation (VA ECMO), the patient's condition deteriorated, and life support was ultimately withdrawn. This case highlights the challenges of managing complex surgical patients and underscores the importance of multidisciplinary care in such cases.