We encountered a case of life-threatening pulmonary embolism (PE) after an extensive retroperitoneal tumor (RT) surgery. The patient complained of abdominal distension. Preoperatively, an ovarian tumor and colon adenoma were suspected. Upon laparotomy, tumor resection and partial rectal resection were performed; the tumor had originated from the retroperitoneum. On postoperative day 11, the patient suddenly went into fatal shock complicated by strong back pain and dyspnea after the continuous pressure drain was removed. Thrombolysis, anticoagulation, and percutaneous catheter-directed treatment were attempted for the massive PE; however, these induced copious intra-abdominal bleeding. A substantial blood transfusion was required, which increased her body mass by 40 kg. On day 22, an intra-abdominal embolism was resected, and hemodynamics stabilized. RTs have a potential risk of perioperative thromboembolism; therefore, we suggest that surgery should take place in an academic hospital with an experienced circulatory team. To preserve life after PE, early diagnosis and multidisciplinary treatment are indispensable.
Keywords: anticoagulant therapy; continuous pressure drain; deep vein thrombosis; gynecology; hemorrhage; multidisciplinary treatment; pelvic tumor; pulmonary embolism; retroperitoneal tumor; va-ecmo.
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