Abstract
A 74-year-old female with BMI of 28.6% came to our hospital complaining of epigasric pain. Abdominal echo and CT study revealed a tumor of 9cm in its largest diameter, anteriorly to the abdominal aorta and inferior vena cava. Incisional biopsy was performed under a laparotomy with operative time of 92 minutes and blood loss of 50gr. Pathological diagnosis was malignant lymphoma. Intermittent pneumatic compression (IPC) was used until immediate postoperative period. The patient could stand up on the 1st postoperative day and could walk on the 2nd postoperative day without problem. On the 4th postoperative day the patient developed dyspnea, loss of consciousness and hypotension. Echo study revealed dilatation of the right ventricle and thrombus in bilateral peroneal vein. CT of the chest revealed a defect of shadow at the bifurcation of the pulmonary artery trunk. Management with t-PA and heparin was started improving the general condition of the patient and a CT study on the 10th postoperative day revealed only a small thrombus in the left pulmonary artery. This case was thought to be in the middle risk level according to the guide-line of thromboembolism prevention protocol and so IPC was applied, but considering the compression of inferior vena cava by a large malignant tumor causing venous stasis, it might have been necessary to adopt a more aggressive preventive measures in the face of added risk factors.
