Acute Aortic Thrombosis Following Anterior Resection - A Rare Complication

Document Type : Case Report

Authors

1 Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Malaysia

2 Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Malaysia.

Abstract

INTRODUCTION : Anterior resection is a commonly performed surgery for rectal cancer worldwide. It is associated with a wide spectrum of complications which include haemorrhage, pelvic sepsis, wound infection, anastomotic breakdown, deep vein thrombosis, peripheral nerves injury, impotence and urological dysfunction. However acute aortic thrombosis post anterior resection is a very rare complication. CASE PRESENTATION : We report a rare case of aortic thrombosis in a 67 year old gentleman following anterior resection for rectal cancer. DISCUSSION : We also discuss its possible causes as there are many postulations to the cause of this devastating complication. Prolonged surgery, abnormal blood coagulation in cancer patient, lithotomy position and the presence of peripheral vascular disease are predisposing factors contributing to this rare acute aortic thrombosis in our patient. A standard routine neurovascular examination of the extremities should be done in the postoperative period to help detect early any neurovascular complication. The use of prophylactic anticoagulant such as fondaparinux, low molecular weight heparin or low dose unfractionated heparin are strongly recommended in high risk surgery patients undergoing a major surgery which helps prevent thromboembolic episode following surgery.

Keywords


  1. Casillas S, Nicholson JD. Aortic thrombosis after low anterior resection for rectal cancer: report of a case. Dis Colon Rectum. 2002;45(6):829-832.
  2. Blann AD and Dunmore S. Arterial and Venous Thrombosis in Cancer Patients. Cardiology Research and Practice, 2011, Article ID 394740.
  3. Minjarez DA, Delorit MA, and Davidson SA. Spontaneous arterial thrombosis with an advanced ovarian malignancy. Gynecologic Oncology, 1997;64(1),176–179.
  4. Cachofeiro V, Miana M, de las Heras Natalia, Martin-Fernandez Beatriz, Ballesteros S, Balfagon G, Lahera V.Inflammation: a link between hypertension and atherosclerosis. Curr Hypertens Rev. 2009;5:40–48.
  5. Hamilton CA, Robinson W. Femoral artery occlusion following pelvic cancer surgery. Gynecol Oncol 1996;63:151–153.
  6. Scott JR, Daneker G, Lumsden AB. Prevention of compartment syndrome associated with the dorsal lithotomy position. Am Surg 1997;63:801-806.
  7. Cardosi RJ, Cox CS, Hoffman MS. Postoperative neuropathies after major pelvic surgery. Obstet Gynecol 2002; 100:240.
  8. Lozman H, McSherry CK, Freund S. Thrombosis of peripheral aneurysms: a complication of colorectal surgery. Dis Colon Rectum 1983;26:167–169.
  9. Irvin W, Andersen W, Taylor P, Rice L. Minimizing the risk of neurologic injury in gynecologic surgery. Obstet Gynecol 2004;103:374.
  10. Dua RS, Bankes MJ, Dowd GS, Lewis AA. Compartment syndrome following pelvic surgery in the lithotomy position. Ann R Coll Surg Engl. 2002;84(3):170-171.
  11. Horgan AF, Geddes S, Finlay IG. Lloyd-Davies position with Trendelenberg-a disaster waiting to happen? Dis Colon Rectum 1999;42:916-919.
  12. Turnbull D, Mills GH. Compartment syndrome associated with the Lloyd Davies position. Three case reports and review of the literature. Anaesthesia. 2001;56(10):980-987.
  13. Agnelli G. Prevention of venous thromboembolism in surgical patients. Circulation. 2004;110(24 Suppl 1):IV4-12.