Post-operatif Beklenmeyen Bilateral Masif Pulmoner Emboli Otuz Yaşında Kadın Hasta: Olgu Sunumu

Pulmoner emboli (PE) seyrek fakat çok ciddi bir komplikasyondur. Genellikle invaziv girişimlerden sonra başlayan ve akciğeri etkileyen komplikasyonlardandır. Bu yazıda 30 yaşında bilateral masif pulmoner emboli gelişen olgu sunulmaktadır. On gün önce over kisti operasyonu geçiren 30 yaşındaki bayan hasta, fenalık ve baygınlık hissi nedeniyle acil servise başvurduğunda kan basıncı 90/40 mmHg, nabız 150/dakika, solunum sayısı 35/dakikaydı. Muayene ve kan alma işlemi sırasında kardiyak arrest geçirdi, oratrakeal entübe edildi ve 3 dakikalık resusitasyona cevap veren hasta, görüntüleme işlemleri sırasında da 3 kez daha kardiyak arrest geçirdi ve yoğun bakım ünitesine kabul edildi. Akut böbrek yetmezliği (ABY) ve pulmoner emboli ön tanısı ile sıvı replasmanı, inotrop desteği ve antikoagulan tedavi ve beyin koruması için sedasyon başlandı. Bu olguda, on gün önce opreasyon geçirmesi ve batın ultrasonunda hemotomu olması trombolitik tedavi açısından mutlak kontrendikasyon olması nedeni ile başlamadık. Pulmoner hipertansiyonu düşürmek amacıyla nikrik oksit inhalasyonu, iloprost inhalasyonu ve sildenafil uygulandı. Yatışının 136. gününde trakeostomize, hipoksik beyin hasarlı, gözleri spontan açık, spontan solunumunda evde bakım hastası olarak taburcu edildi. Pulmoner embolide erken tanı ve tedavi, hayatı tehdit eden komplikasyonlardan korunmak ve iyi prognoz için çok önemlidir.

Post-operative Unexpected Bilateral Massive Pulmonary Embolism in a Thirty-Year-Old Woman: A Case Report

Pulmonary embolism (PE) is a rare, yet serious complication. That, generally follows invasive procedures in adults. The present report details the case of bilateral pulmonary embolism in a thirty-year- old women after ovarian cyst surgery. A thirty-year-old female patient, who had ovarian cystectomy ten days previously, consulted the emergency department with the complaints of sickness and syncope. Her blood pressure, pulse and respiratory rate were 90/40 mmHg, 150/min. and 35/min, respectively. During examination and phlebotomy, she had a cardiac arrest and responded to a 3-minute cardiopulmonary resuscitation (CPR) with tracheal intubation. During imaging procedures, she had three further cardiac arrests and was admitted to the intensive care unit. The preliminary diagnoses were acute renal failure (ARF) and PE. Fluid replacement, inotropic support, anticoagulant therapies, as well as sedation to prevent brain damage were started immediately. Thrombolytic therapy was not attempted because she had surgery ten days ago and hematoma was observed on abdominal ultrasound. Inhaled nitric oxide and inhaled iloprost with sildenafil were employed to reduce pulmonary hypertension. When discharged 136 days after hospitalization she was a tracheotomized and, spontaneously breathing home care patient with hypoxic brain injury. Early detection and treatment of PE are of great importance for a good prognosis and prevention of life-threatening complications.

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