Pathology Department, Hospital del Mar, Barcelona, Spain.
Surgery Department, Hospital del Mar, Barcelona, Spain.
Forensic Sci Med Pathol. 2024 Jun;20(2):668-674. doi: 10.1007/s12024-023-00615-4. Epub 2023 Mar 17.
Pulmonary embolism (PE) is a common cause of death in hospitalized patients. These emboli are usually related to deep venous thrombosis, but other etiologic factors may be the cause. A 60-year-old male was diagnosed with rectal adenocarcinoma and treated by surgical rectal resection. After surgery, he presented with a decreased level of consciousness and hypoxia with no signs of bleeding. PE was ruled out by pulmonary angiography. Given the hemodynamic instability, contrast-enhanced CT was performed, showing a discrete leak related to the rectal anastomosis, which required urgent surgery. The patient suffered cardiorespiratory arrest prior to surgery, and once resolved, the surgical procedure was limited to disconnecting the intestinal anastomosis, leaving the colon and rectal stumps free in the abdomen and keeping the abdominal cavity open with negative-pressure therapy. The patient suffered from another cardiorespiratory arrest after surgery, with abdominal distension and serous-hemorrhagic material discharge through the negative-pressure device. On a new surgical revision, no bleeding was identified, so the symptoms were attributed to coagulopathy. The patient died and autopsy was performed. The autopsy revealed no surgery-related complications. The lungs were increased in weight and showed a normal macroscopic appearance; in contrast, the histological study revealed multiple and bilateral thrombo-embolisms affecting small distal arteries. Those thrombi were composed of intestinal contents, including vegetal particles, mucinous and biliary material, fibrin, and bacterial structures. Fecal PE is an extremely infrequent event. Isolated cases have been described in association with communications between the digestive tract lumen and the systemic circulation, with a generally fatal prognosis.
肺栓塞（PE）是住院患者死亡的常见原因。这些栓子通常与深静脉血栓形成有关，但其他病因也可能是致病因素。一名 60 岁男性被诊断患有直肠腺癌，并接受了直肠切除术。手术后，他出现意识水平下降和缺氧，无出血迹象。通过肺动脉造影排除了肺栓塞。由于血流动力学不稳定，进行了增强 CT 检查，显示与直肠吻合口相关的离散渗漏，需要紧急手术。在手术前，患者发生了心肺骤停，一旦解决，手术仅限于断开肠吻合口，使结肠和直肠残端游离在腹部，并通过负压治疗保持腹部开放。手术后患者再次发生心肺骤停，腹部膨胀，通过负压设备排出浆液血性物质。在新的手术修订中，没有发现出血，因此症状归因于凝血功能障碍。患者死亡并进行了尸检。尸检未发现与手术相关的并发症。肺部重量增加，肉眼观察正常；然而，组织学研究显示，多个双侧血栓栓塞影响小远端动脉。这些血栓由肠内容物组成，包括植物颗粒、黏液和胆汁物质、纤维蛋白和细菌结构。粪便性肺栓塞是一种极其罕见的事件。已经描述了与消化道腔和体循环之间存在沟通的孤立病例，预后通常是致命的。
