A Case of Acute Pulmonary Thromboembolism Leading to Cardiopulmonary Arrest Three Days after Total Gastrectomy with Survival Due to Percutaneous Cardiopulmonary Support and Surgical Thrombectomy

Abstract

A 72-year-old man underwent open total gastrectomy for gastric cancer and had cardiopulmonary arrest following loss of consciousness on the third day after surgery. After the start of cardiopulmonary resuscitation and induction of percutaneous cardiopulmonary support (PCPS), acute pulmonary thromboembolism was suspected based on findings of right ventricular enlargement and left ventricular exclusion on echocardiography. Enhanced CT showed giant emboli in both pulmonary arteries, and acute pulmonary thromboembolism was diagnosed. Since it was 3 days after the operation, surgical thrombectomy was selected instead of thrombolytic therapy based on the risk of postoperative bleeding. Immediately after thrombectomy, hemodynamics and oxygenation improved. The patient was hospitalized for a long time due to a lung abscess during the postoperative course, but there were no neurological sequelae and he was discharged from hospital 52 days after thrombectomy. We report a case of acute pulmonary thromboembolism leading to cardiopulmonary arrest after gastric cancer surgery, in which the patient was saved by rapid induction of PCPS and surgical thrombectomy.