Acute pulmonary embolism after colorectal surgery

A 84-year-old woman presented with abdominal pain and tarry stools. She was admitted to our hospital, and colonofiberscopy showed type II tumor located cecum. We prevented deep vein thrombosis and acute pulmonary embolism (APE) after abdominal surgery by using the elastic stockings and intermittent pneumatic compression system in operation room. She underwent ileocecal resection and lymphonodi dissection (D2). On 2nd postoperative day, she complained of sudden respiratory distress with loss of consciousness and went into the state of shock. We made the diagnosis of APE after reviewing chest computed tomography and cardiac echo. An emergency atrial and pulmonary thromboembolectomy under cardiopulmonary bypass was performed. We removed the thrombus from right atrium and bilateral main pulmonary artery. After operation, we inserted a temporary vena cava filter into vena cava. We performed the anticoagulant therapy by continuous infusion of heparin with assisting respiration by respirator. The pulmonary artery pressure became steady about 25 approximately 30 mmHg. On 14th postoperative day, we extubated tracheotube. On 40th postoperative day, she could discharge from hospital on foot. Early diagnosis and prompt treatment for APE are important, and we should always keep APE in mind after abdominal surgery.