title: [Two cases of early postoperative massive pulmonary thromboembolism after gastric bypass surgery].
abstract: Pulmonary thromboembolism in the early postoperative period is rare. We present 2 cases of massive embolism that occurred soon after gastric bypass surgery. The first patient was a 32-year-old man, a smoker with a body mass index (BMI) of 52 kg/m2, obstructive sleep apnea-hypopnea syndrome and venous insufficiency in the lower extremities. Fatal cardiorespiratory arrest occurred 22 hours after surgery. Autopsy confirmed massive pulmonary thromboembolism. The second patient was a 48-year-old woman with a BMI of 40 kg/m2 who had undergone abdominal hysterectomy 2 months earlier. She survived cardiorespiratory arrest occurring 11 hours after surgery. There were no sequelae. The diagnosis of pulmonary thromboembolism was confirmed by transesophageal echocardiography. These patients undoubtedly had asymptomatic deep vein thrombosis before the operations. Prevention of pulmonary embolism is essential in high risk patients. The prophylactic measures usually applied are administration of low molecular weight heparin to prevent thrombosis, early ambulation, and the use of elastic compression stockings or intermittent pneumatic compression.
authors.affiliation: Servicio d'Anestesiologia i Reanimación, Hospital Universitari de Girona Dr. Josep Trueta, Avd/ França s/n 17001 Girona. fparramon@comg.es
authors.forename: F
authors.initials: F
authors.lastname: Parramón
authors.forename: O
authors.initials: O
authors.lastname: Pineda
authors.forename: B
authors.initials: B
authors.lastname: Pardina
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez
authors.forename: B
authors.initials: B
authors.lastname: Ruiz
authors.forename: A
authors.initials: A
authors.lastname: Villalonga
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D003131:Combined Modality Therapy; D015897:Comorbidity; D004837:Epinephrine / Q000627:therapeutic use; D017809:Fatal Outcome; D015390:Gastric Bypass; D006323:Heart Arrest / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007044:Hysterectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011292:Premedication; D011655:Pulmonary Embolism / Q000209:etiology* / Q000503:physiopathology; D013610:Tachycardia / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D004837:Epinephrine