Sagalov Andrew, Allen Sorcha, Iqbal Omer, Darki Amir
Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA.
Interventional Cardiology, Loyola University Medical Center, Maywood, USA.
Cureus. 2021 Aug 13;13(8):e17162. doi: 10.7759/cureus.17162. eCollection 2021 Aug.
The evaluation of patients with pulmonary embolism (PE) requires a comprehensive approach that assesses physical and laboratory exam findings, interprets varying imaging modalities, and selects appropriate treatment strategies. Comorbidities can complicate treatment and influence physicians to make difficult management decisions. In this case report, we present a patient with a small bowel obstruction complicated by submassive intermediate high-risk PE. Stratifying risk in PE patients is crucial to gauge when to use invasive interventions. There is limited clinical data to identify the optimal timing of surgery in patients with concurrent PE. We describe a challenging case where a patient requires multiple life-saving interventions; however, each treatment method carries a risk of bleeding or further complicating surgical candidacy. The patient in question first undergoes treatment of PE to improve hemodynamics and lower the clot burden prior to proceeding with resection of the small bowel. This report emphasizes the utility of the Pulmonary Embolism Response Team to facilitate care when surgical comorbidities require immediate attention as well.
对肺栓塞（PE）患者的评估需要一种全面的方法，该方法要评估体格检查和实验室检查结果，解读各种成像方式，并选择合适的治疗策略。合并症会使治疗复杂化，并影响医生做出艰难的管理决策。在本病例报告中，我们介绍了一名患有小肠梗阻并伴有亚大块中间高危PE的患者。对PE患者进行风险分层对于判断何时使用侵入性干预措施至关重要。目前识别并发PE患者的最佳手术时机的临床数据有限。我们描述了一个具有挑战性的病例，该患者需要多次挽救生命的干预措施；然而，每种治疗方法都有出血风险或使手术候选资格进一步复杂化。该患者首先接受PE治疗，以改善血流动力学并降低血栓负荷，然后再进行小肠切除术。本报告强调了肺栓塞反应团队在手术合并症也需要立即关注时促进护理的作用。
