Postoperative Extensive Venous Thrombosis Occurring in the Inferior Vena Cava after Septic Shock Caused by Stercoral Perforation of the Sigmoid Colon

Abstract

A 48-year-old woman consulted a physician for abdominal pain following constipation for 10 days. She was given enema treatment. The next day, she was admitted with generalized peritonitis and shock. A central venous catheter was inserted via the right femoral vein. Abdominal computed tomography (CT) showed free air and massive ascites centering on the pelvis. Generalized peritonitis due to gastrointestinal perforation was diagnosed and emergency surgery was conducted, revealing an oval 2.0 centimeter perforation in the sigmoid colon with fecal escape. We diagnosed stercoral perforation of the colon and conducted Hartmann's operation. Although the patient suffered from multiple organ failure, she recovered. The central venous catheter was removed on postoperative day 11. There was prolonged high fever, and thrombi in the right external and common iliac vein and inferior vena cava (IVC) were detected on CT on postoperative day 30. Immediately, an IVC filter was inserted, and the patient was treated with thrombolytic and anticoagulation therapy. CT revealed no change in the condition of the thrombi and the patient was discharged on postoperative day 76. She continued anticoagulation therapy with Warfarin, and the IVC thrombus disappeared on the seventh month after surgery. The present case highlights the risk of postoperative venous thrombosis after implantation of a central venous catheter through the inferior vena cava and septic insult.