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: Case report  USA

[In Press] Fatal Sequelae of Reperfusion Injury in Postoperative Gastric Bypass

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment

Zachary J. Naser1ABEF, Karleigh R. Curfman1ABEF, Meaghan M. Marley1ABEF, D'Arcy N. Duke1ABEF

Am J Case Rep In Press; DOI:   :: ID: 936270

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Obesity is a pandemic that is currently uncontrolled. In the surgical population, bariatric surgery is a sustainable and attractive option. However, both obesity and surgery can independently increase the risk for venous thromboembolism and subsequent significant and even fatal adverse effects.
CASE REPORT
We present the unique case of a 63-year-old woman who developed substantial venous thrombosis in the postoperative period following a laparoscopic hiatal hernia repair and Roux-en-Y gastric bypass. Venous thrombosis following surgery is a known possible complication, but we felt that this case required reporting due to the extreme extent of thrombosis and the significant course of events that occurred following her readmission. Due to the increased thrombus burden, the patient developed phlegmasia cerulea dolens and required operative thrombectomy. With restoration of blood flow following the procedure, the patient’s clinical status rapidly declined, likely due to reperfusion injury. Ultimately, she developed multisystem organ failure, which included the constellation of shock, hypoxic respiratory failure, acute renal failure, shock liver, and, finally, cardiopulmonary arrest.
CONCLUSIONS
As the authors of this paper, we were especially inclined to report this particular case as the patient’s clinical course was exceedingly complex due to her presenting phlegmasia cerulea dolens. The course was further complicated postoperatively by the detrimental sequelae of massive reperfusion injury, which likely eventually led to her death. We felt this pertinent to present because, after an extensive PubMed literature review, this sequence of events following gastric bypass surgery has yet to be reported in the literature.

Keywords: Gastric Bypass; Reperfusion Injury; Venous Thromboembolism; Abdominal Obesity Metabolic Syndrome

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923