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Thrombose der Vena cava inferior nach diagnostischer Laparoskopie


Cadosch, D; Scheyerer, M J; Binkert, C; Wigger, P (2011). Thrombose der Vena cava inferior nach diagnostischer Laparoskopie. Deutsche Medizinische Wochenschrift, 136(28-29):1472-1475.

Abstract

HISTORY AND FINDINGS:

A previously healthy 43-year-old woman was admitted because of pain in the lower abdomen. Abdominal and transvaginal ultrasound revealed a cystic structure in the right ovary, providing the indication for an exploratory laparoscopy. A hemorrhagic corpus luteum was enucleated. Laboratory tests had merely shown a raised C-reactive protein level and marginally elevated leukocytes. A family history of thrombotic episodes had been elicited. FURTHER COURSE,
DIAGNOSIS AND TREATMENT:

Although heparin had been applied increasing swelling developed in both thighs and lower legs at day six, indicating thrombosis of the inferior vena cava. Laboratory tests revealed a mutation in factor V (Leiden). Computed tomography showed complete thrombotic IVC occlusion. Thrombolytic treatment with recombinant tissue plasminogen was initiated, direct thrombus aspiration attempted and a filter inserted in the IVC. Low molecular heparin was infused, replaced by oral anticoagulation with phenprocoumon. Subsequent Doppler ultrasound examination demonstrated almost complete resolution of the thrombus, except for a few small residual thrombi.
CONCLUSION:

This case demonstrates that even minor laparoscopic interventions carry the risk of an IVC thrombosis as a late complication, indicating appropriate measures to prevent thrombosis.

Georg Thieme Verlag KG Stuttgart · New York.


Zusammenfassung:

Anamnese und Befunde: Bei einer 43-jährigen, bislang gesunden Frau erfolgte wegen akuter Unterbauchschmerzen und sonographisch zystischer Struktur im Bereich des rechten Ovars eine explorative Laparoskopie. Dabei wurde ein hämorrhagisches Corpus luteum enukleiert. Laborchemisch zeigten sich lediglich ein leicht erhöhtes CRP sowie grenzwertig erhöhte Leukozyten. Auffällig war eine positive Familienanamnese für thrombotische Ereignisse.

Verlauf, Diagnose und Therapie: Trotz Thromboseprophylaxe kam es am sechsten postoperativen Tag zu zunehmenden Schmerzen in beiden Oberschenkeln sowie Schwellung beider Beine. Im Computertomogramm zeigte sich ein kompletter thrombotischen Verschluss der Vena cava inferior. Untersuchungen hinsichtlich eines genetischen Gerinnungsdefektes offenbarten eine Faktor-V-Leiden-Mutation. Nach Diagnose einer Vena-cava-inferior-Thrombose wurde oberhalb des Thrombus ein Cava-Schirm sowie eine Thrombolyse eingeleitet. Eine am fünften Tag nach Therapiebeginn durchgeführte sonographische Duplexuntersuchung zeigte bis auf wenige kleine Restthrombosen der infrarenalen Abschnitte eine nahezu komplette Auflösung des Thrombus.

Folgerung: Nach großen bauchchirurgischen Eingriffen gelten Thrombosen der Vena cava inferior als mögliche Spätkomplikation. Der vorliegende Fall zeigt allerdings, dass auch nach kleinen laparoskopischen Eingriffen die Gefahr der Entwicklung einer entsprechenden Thrombose besteht und eine Prophylaxe unerlässlich ist.
Abstract

History and findings: A previously healthy 43-year-old woman was admitted because of pain in the lower abdomen. Abdominal and transvaginal ultrasound revealed a cystic structure in the right ovary, providing the indication for an exploratory laparoscopy. A hemorrhagic corpus luteum was enucleated. Laboratory tests had merely shown a raised C-reactive protein level and marginally elevated leukocytes. A family history of thrombotic episodes had been elicited.

Further course, diagnosis and treatment: Although heparin had been applied increasing swelling developed in both thighs and lower legs at day six, indicating thrombosis of the inferior vena cava. Laboratory tests revealed a mutation in factor V (Leiden). Computed tomography showed complete thrombotic IVC occlusion. Thrombolytic treatment with recombinant tissue plasminogen was initiated, direct thrombus aspiration attempted and a filter inserted in the IVC. Low molecular heparin was infused, replaced by oral anticoagulation with phenprocoumon. Subsequent Doppler ultrasound examination demonstrated almost complete resolution of the thrombus, except for a few small residual thrombi.

Conclusion: This case demonstrates that even minor laparoscopic interventions carry the risk of an IVC thrombosis as a late complication, indicating appropriate measures to prevent thrombosis.

Abstract

HISTORY AND FINDINGS:

A previously healthy 43-year-old woman was admitted because of pain in the lower abdomen. Abdominal and transvaginal ultrasound revealed a cystic structure in the right ovary, providing the indication for an exploratory laparoscopy. A hemorrhagic corpus luteum was enucleated. Laboratory tests had merely shown a raised C-reactive protein level and marginally elevated leukocytes. A family history of thrombotic episodes had been elicited. FURTHER COURSE,
DIAGNOSIS AND TREATMENT:

Although heparin had been applied increasing swelling developed in both thighs and lower legs at day six, indicating thrombosis of the inferior vena cava. Laboratory tests revealed a mutation in factor V (Leiden). Computed tomography showed complete thrombotic IVC occlusion. Thrombolytic treatment with recombinant tissue plasminogen was initiated, direct thrombus aspiration attempted and a filter inserted in the IVC. Low molecular heparin was infused, replaced by oral anticoagulation with phenprocoumon. Subsequent Doppler ultrasound examination demonstrated almost complete resolution of the thrombus, except for a few small residual thrombi.
CONCLUSION:

This case demonstrates that even minor laparoscopic interventions carry the risk of an IVC thrombosis as a late complication, indicating appropriate measures to prevent thrombosis.

Georg Thieme Verlag KG Stuttgart · New York.


Zusammenfassung:

Anamnese und Befunde: Bei einer 43-jährigen, bislang gesunden Frau erfolgte wegen akuter Unterbauchschmerzen und sonographisch zystischer Struktur im Bereich des rechten Ovars eine explorative Laparoskopie. Dabei wurde ein hämorrhagisches Corpus luteum enukleiert. Laborchemisch zeigten sich lediglich ein leicht erhöhtes CRP sowie grenzwertig erhöhte Leukozyten. Auffällig war eine positive Familienanamnese für thrombotische Ereignisse.

Verlauf, Diagnose und Therapie: Trotz Thromboseprophylaxe kam es am sechsten postoperativen Tag zu zunehmenden Schmerzen in beiden Oberschenkeln sowie Schwellung beider Beine. Im Computertomogramm zeigte sich ein kompletter thrombotischen Verschluss der Vena cava inferior. Untersuchungen hinsichtlich eines genetischen Gerinnungsdefektes offenbarten eine Faktor-V-Leiden-Mutation. Nach Diagnose einer Vena-cava-inferior-Thrombose wurde oberhalb des Thrombus ein Cava-Schirm sowie eine Thrombolyse eingeleitet. Eine am fünften Tag nach Therapiebeginn durchgeführte sonographische Duplexuntersuchung zeigte bis auf wenige kleine Restthrombosen der infrarenalen Abschnitte eine nahezu komplette Auflösung des Thrombus.

Folgerung: Nach großen bauchchirurgischen Eingriffen gelten Thrombosen der Vena cava inferior als mögliche Spätkomplikation. Der vorliegende Fall zeigt allerdings, dass auch nach kleinen laparoskopischen Eingriffen die Gefahr der Entwicklung einer entsprechenden Thrombose besteht und eine Prophylaxe unerlässlich ist.
Abstract

History and findings: A previously healthy 43-year-old woman was admitted because of pain in the lower abdomen. Abdominal and transvaginal ultrasound revealed a cystic structure in the right ovary, providing the indication for an exploratory laparoscopy. A hemorrhagic corpus luteum was enucleated. Laboratory tests had merely shown a raised C-reactive protein level and marginally elevated leukocytes. A family history of thrombotic episodes had been elicited.

Further course, diagnosis and treatment: Although heparin had been applied increasing swelling developed in both thighs and lower legs at day six, indicating thrombosis of the inferior vena cava. Laboratory tests revealed a mutation in factor V (Leiden). Computed tomography showed complete thrombotic IVC occlusion. Thrombolytic treatment with recombinant tissue plasminogen was initiated, direct thrombus aspiration attempted and a filter inserted in the IVC. Low molecular heparin was infused, replaced by oral anticoagulation with phenprocoumon. Subsequent Doppler ultrasound examination demonstrated almost complete resolution of the thrombus, except for a few small residual thrombi.

Conclusion: This case demonstrates that even minor laparoscopic interventions carry the risk of an IVC thrombosis as a late complication, indicating appropriate measures to prevent thrombosis.

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Additional indexing

Other titles:Inferior vena cava thrombosis after laparoscopy
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2011
Deposited On:14 Jan 2012 13:30
Last Modified:17 Feb 2018 14:34
Publisher:Thieme
ISSN:0012-0472
OA Status:Closed
Publisher DOI:https://doi.org/10.1055/s-0031-1281538
PubMed ID:21732261

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