Lower limb exsanguination and embolism.
We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. Resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.
Department of Anaesthesiology, Charleroi University Hospital Centre, Belgium.
J G
JG
Boogaerts
D000368:Aged; D000775:Anesthesia, Spinal; D001049:Apnea / Q000209:etiology; D001458:Bandages / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005592:Fracture Fixation; D006801:Humans; D007431:Intraoperative Complications; D007866:Leg / Q000098:blood supply*; D011152:Popliteal Vein; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D012769:Shock / Q000209:etiology; D013977:Tibia / Q000098:blood supply; D014111:Tourniquets / Q000009:adverse effects*; D014474:Unconsciousness / Q000209:etiology; D014680:Veins; D020246:Venous Thrombosis / Q000150:complications