Endo Masahide, Tanaka Yoshihiro, Sato Yuta, Ohno Shinya, Yoshida Kazuhiro
Department of Gastroenterology, Gifu University School of Medicine, Gifu City 501-1194, Japan.
Department of Gastroenterology, Gifu University School of Medicine, Gifu City 501-1194, Japan.
Int J Surg Case Rep. 2022 Mar;92:106836. doi: 10.1016/j.ijscr.2022.106836. Epub 2022 Feb 14.
Venous thromboembolism (VTE) is a serious postoperative complication with potentially fatal outcome. However, asymptomatic VTE is difficult to diagnose and is often discovered by chance. We report a case of suspected VTE diagnosed based on prolonged fever after surgery and discuss the literature.
A 48-year-old man was referred to us with a diagnosis of gastric cancer. Upper gastrointestinal endoscopy revealed a neoplastic lesion from the anterior wall of the mid-gastric mass to the upper part of the gastric body, and biopsy revealed adenocarcinoma. Contrast-enhanced computed tomography (CT) showed no obvious distant metastasis. The preoperative diagnosis was gastric cancer, cT4aN1M0 cStage III, and radical surgery was performed. During surgery, an intermittent pneumatic compression pump was used. Subcutaneous injection of enoxaparin was started postoperatively. A high fever continued on postoperative day 4, and high D-dimer level of 14.3 μg/mL was found. Contrast-enhanced CT scanning showed thrombus in the left upper lobe pulmonary artery A4/5. Lower extremity venous ultrasonography revealed a thrombus in the right soleal vein, and apixaban 20 mg/day was started that day. Thereafter, fever resolved quickly, and the D-dimer level gradually decreased. The patient was discharged from hospital on day 21 having made good progress.
It sould be rememberd that there are VTE found in persistent fever after gastric cancer surgery. The main complaint was simply fever, and the fever disappeared with anticoagulant.
This cases suggests the importance of perioperative measures against VTE. Peri operative treatment with apixaban was safe and effective.
静脉血栓栓塞症（VTE）是一种严重的术后并发症，可能导致致命后果。然而，无症状VTE难以诊断，常偶然发现。我们报告一例基于术后持续发热诊断为疑似VTE的病例并讨论相关文献。
一名48岁男性因胃癌诊断被转诊至我院。上消化道内镜检查发现胃中部肿块前壁至胃体上部有肿瘤性病变，活检显示为腺癌。增强计算机断层扫描（CT）未显示明显远处转移。术前诊断为胃癌，cT4aN1M0，c期III，行根治性手术。手术期间使用了间歇性气动压迫泵。术后开始皮下注射依诺肝素。术后第4天持续高热，D-二聚体水平高达14.3μg/mL。增强CT扫描显示左上叶肺动脉A4/5有血栓。下肢静脉超声检查显示右比目鱼静脉有血栓，当日开始服用阿哌沙班20mg/天。此后，发热迅速消退，D-二聚体水平逐渐下降。患者于第21天顺利出院。
应记住胃癌手术后持续发热时可能存在VTE。主要症状仅为发热，使用抗凝剂后发热消失。
本病例提示围手术期预防VTE措施的重要性。围手术期使用阿哌沙班治疗安全有效。
