18 February 2020 : Case report
Thrombolysis in Postoperative Pulmonary Embolism Following Liver Transplantation: A Case Report
Unusual or unexpected effect of treatmentThamer H. Al-Ghamdi1ABCDEFG*, Anwar Jarrad2AB, Abdalla Younes Bashir3AB, Thomas Lorf4AB, Aiman Obed3ABCG
Am J Case Rep 2020; 21:e918857
BACKGROUND: Postoperative pulmonary embolism following liver transplantations is still one of the most fatal complications, especially during the early postoperative phase. The use of a thrombolytic agent such as the recombinant tissue-type plasminogen activator (rtPA) is considered a contraindication early after major abdominal surgery such as liver transplantation. However, thrombolysis after major surgery in the early postoperative period carries a substantial risk of surgical site hemorrhage.
CASE REPORT: A 55-year-old patient presented with a hepatic mass diagnosed as a combined cholangio/hepatocellular carcinoma. Following the criteria of the University of San Francisco, California (UCSF) for liver transplantation, the case was selected for liver transplantation. The patient received neoadjuvant therapy. After the liver transplantation, on the second postoperative day, an acute, severe dyspnea with sudden onset occurred on the surgical ward. A computed tomography angiography showed a drawn-out embolus, which sprawled into both pulmonary main arteries and occluded them subtotally. A thrombolysis with rtPA was started. Within the first 60 minutes of administration of rtPA, the circulation stabilized effectively, so that epinephrine could be tapered down to zero and the patient was promptly extubated. About 6 hours after administration of rtPA, a sudden and pronounced bleeding via one of the intraperitoneal drains occurred, hemoglobin concentration dropped from 9.7 g/dL to 6.4 g/dL. After immediate re-laparotomy, circulation and hemoglobin concentration were absolutely stable.
CONCLUSIONS: Even with anticipated high risk of bleeding, thrombolysis with rtPA can be used as a life-savings treatment in a case of pulmonary embolism after liver transplantation.
Keywords: Liver Transplantation, Pulmonary Embolism, Tissue Plasminogen Activator, Dyspnea, Fibrinolytic Agents, Middle Aged, Postoperative Complications
25 May 2023 : Case reportNeuroendocrine Carcinoma of the Extrahepatic Bile Ducts: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939239
24 May 2023 : Case reportAn Initially Missed Diagnosis of Venous Thromboembolic Phenomenon in Adult-Onset Still’s Disease: A Case Re...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939520
24 May 2023 : Case reportSuccessful Surgical Removal of a Giant Serous Ovarian Cyst in a 52-Year-Old Woman with Presurgical Body Mas...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939697
23 May 2023 : Case reportSuccessful Noninvasive Respiratory Management of an Infant with Bilateral Choanal Atresia and a Supernumera...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939642
Most Viewed Current Articles
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347