TY - JOUR
T1 - Severe perioperative bleeding in renal cell carcinoma after elective pericardiocentesis associated left ventricular puncture
T2 - case report
AU - Lasala, Javier
AU - Patino, Miguel Alejandro
AU - Mena, Gabriel
AU - Vachhani, Shital
AU - Moon, Teresa
AU - Bui, Thao
AU - Tsai, January
PY - 2016/7/12
Y1 - 2016/7/12
N2 - In the United States during the year 2015, approximately 61,560 patients are expected to be diagnosed with kidney cancer and 14,080 to die from the disease. We present the case of a patient with renal cell carcinoma who suffered severe perioperative bleeding and coagulopathy after emergency sternotomy. We also engage in relevant aspects of perioperative anesthesia care including the considerations and management of coagulopathy, liver failure and renal failure in the oncologic patient. The case is a 49-year-old man with vena cava tumor thrombus who underwent radiologic tumor embolization, left radical nephrectomy, and inferior vena cava (IVC) thrombectomy. Postoperatively, he developed sepsis, multiple organ failure, and a pericardial effusion requiring pericardiocentesis. During pericardiocentesis, he suffered an iatrogenic left entricular perforation, requiring an emergency sternotomy and left ventricular repair. Cancer patients are often challenging for surgical and anesthesia teams, emergency care requires an organized and comprehensive approach. The use of recombinant factor VIIa NovoSeven can help in managing severe postoperative bleeding after cardiothoracic surgery in oncologic patients, but further studies should be done to confirm this.
AB - In the United States during the year 2015, approximately 61,560 patients are expected to be diagnosed with kidney cancer and 14,080 to die from the disease. We present the case of a patient with renal cell carcinoma who suffered severe perioperative bleeding and coagulopathy after emergency sternotomy. We also engage in relevant aspects of perioperative anesthesia care including the considerations and management of coagulopathy, liver failure and renal failure in the oncologic patient. The case is a 49-year-old man with vena cava tumor thrombus who underwent radiologic tumor embolization, left radical nephrectomy, and inferior vena cava (IVC) thrombectomy. Postoperatively, he developed sepsis, multiple organ failure, and a pericardial effusion requiring pericardiocentesis. During pericardiocentesis, he suffered an iatrogenic left entricular perforation, requiring an emergency sternotomy and left ventricular repair. Cancer patients are often challenging for surgical and anesthesia teams, emergency care requires an organized and comprehensive approach. The use of recombinant factor VIIa NovoSeven can help in managing severe postoperative bleeding after cardiothoracic surgery in oncologic patients, but further studies should be done to confirm this.
KW - hemorrhage
KW - pericardiocentesis
KW - perioperative care
KW - renal cell carcinoma
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UR - http://www.scopus.com/inward/citedby.url?scp=85028689782&partnerID=8YFLogxK
U2 - 10.5867/medwave.2016.06.6494
DO - 10.5867/medwave.2016.06.6494
M3 - Article
C2 - 27420728
AN - SCOPUS:85028689782
SN - 0717-6384
VL - 16
SP - e6494
JO - Medwave
JF - Medwave
IS - 6
ER -