Management of a patient with perioperative saddle embolus

Abstract

Pulmonary embolism is a major cause of morbidity and mortality. Risk factors include venous stasis, endothelial injury, and hypercoagulability. Prevention centers on the use of sequential compression devices and anticoagulation in the hospital patient. This is the case of a 45-year-old male who presented for open reduction and internal fixation of tibia plateau fracture. He developed a saddle embolus during the perioperative period which was diagnosed in the recovery room after workup for the cause of his poor oxygenation. A chest computed tomographic scan showed an extensive saddle embolus with partial occlusion of the bilateral main pulmonary arteries and all segmental pulmonary artery branches. This case report discusses his diagnosis, management and clinical course. In addition, risk factors, treatment and prevention for pulmonary embolus and described.

Keywords: Venous thromboembolism, Pulmonary embolus, Saddle embolus, Tibia fracture, Anesthesia

Core tip: The case report describes the diagnosis, management and treatment of a 45-year-old male who developed a saddle pulmonary embolus during open reduction and internal fixation of tibia plateau fracture. The incidence of pulmonary embolism, risk factors, and treatment and prevention choices are discussed.