Dos casos de tromboembolismo pulmonar masivo precoz en el postoperatorio de cirugía bariátrica / Two cases of early postoperative massive pulmonary thromboembolism after gastric bypass surgery

RESUMEN

El tromboembolismo pulmonar (TEP) en las primeras horas del postoperatorio es poco habitual. Presentamos dos casos de TEP masivo precoz que ocurrieron en las primeras horas después de cirugía bariátrica. El primer caso era un varón de 32 años, fumador, con índice de masa corporal (IMC) 52 kg/m2, síndrome de apnea obstructiva del sueño e insuficiencia venosa en extremidades inferiores. A las 22 horas del postoperatorio presentó colapso cardiorrespiratorio mortal. La necropsia confirmó TEP masivo. El segundo caso era una mujer de 48 años con IMC 40 kg/m2, operada dos meses antes de histerectomía abdominal. A las 11 horas postcirugía presentó colapso cardiopulmonar del cual sobrevivió sin secuelas. La ecocardiografía transesofágica confirmó el diagnóstico de TEP masivo. Seguramente estos pacientes presentaban trombosis venosa profunda asintomática preoperatoria. La prevención del TEP es fundamental en pacientes de alto riego, las medidas más comúnmente usadas son la tromboprofilaxis con heparina de bajo peso molecular, combinada con la deambulación precoz, medias de compresión elástica o compresión neumática intermitente (AU)

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 (AU)