Systemic thrombolysis for acute submassive pulmonary embolism after laparoscopic Roux-en-Y bypass: A case report

Alejandro Brañes; Matias Orellana; Rodrigo Muñoz

doi:10.1016/j.ijscr.2019.01.005

Systemic thrombolysis for acute submassive pulmonary embolism after laparoscopic Roux-en-Y bypass: A case report

Int J Surg Case Rep. 2019:55:66-68. doi: 10.1016/j.ijscr.2019.01.005. Epub 2019 Jan 19.

Authors

Alejandro Brañes¹, Matias Orellana², Rodrigo Muñoz³

Affiliations

¹ Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
² Affiliate to Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
³ Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile. Electronic address: rmunozc@med.puc.cl.

Abstract

Introduction: Venous thromboembolism (VTE) in bariatric surgery is a low incidence disease; however, it is the first cause of morbimortality in this group of patients.

Presentation of the case: We present the case of a female patient with morbid obesity who was readmitted due to an acute submassive bilateral pulmonary embolism (PE) nineteen days after a laparoscopic Roux-en-Y gastric bypass (RYGB). After diagnosis, anticoagulation was initiated, and decision to add mechanical and pharmacological thrombolysis was made with the patient been successfully treated, as shown by normalization of pulmonary hypertension.

Discussion: VTE in bariatric surgery is rare but contributes to significant morbidity and mortality in patients undergoing bariatric surgery.

Conclusion: It is necessary to have a high index of suspicion to make a timely diagnosis and initiate an early treatment. In selected cases, adding mechanical and pharmacological thrombolysis could increase chance of reverse pulmonary hypertension.

Keywords: Case report; Laparoscopic Roux-en-Y gastric bypass; Pulmonary embolism; Thrombolysis; Venous thromboembolism.