Deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) is a serious condition that requires prompt and appropriate diagnosis and treatment. We report a case of head and neck surgery for a tumor in a patient with idiopathic thrombocytopenic purpura (ITP) who developed DVT/PTE and postoperative hemorrhage that were difficult to manage. The patient was a 60-year-old woman with ITP who was diagnosed as having desmoid-type fibromatosis in the head and neck region. Two days after the surgery, a decrease in blood oxygen level was detected and a chest CT was performed, which confirmed the onset of DVT/PTE, and we started the patient on anticoagulant therapy. Due to the use of anticoagulants, she developed recurrent postoperative hemorrhage which proved difficult to control. We stopped the anticoagulants and controlled the hemorrhage by applying a hemostatic agent and applying pressure to the wound. The DVT/PTE resolved, and the patient was discharged from the hospital on the 19th day after surgery.
It is necessary to consider the high risk of development of DVT/PTE in cases with ITP undergoing surgery. In such cases, early diagnosis and prompt treatment are crucial. The treatment for DVT/PTE is anticoagulation, but there is a possibility that this will result in difficult-to-control postoperative hemorrhage. When postoperative hemorrhage complicates DVT/PTE treatment, careful airway management is necessary, especially in patients undergoing head and neck surgery. In patients at a high risk of developing DVT/PTE, it is important to prevent the onset of the disease, but in cases where there is a risk of hemorrhage, such as in patients with ITP, this could prove challenging. Selection of anticoagulant therapy for preventing DVT/PTE should be considered on an individual-case basis, taking into consideration the risk of hemorrhage.
