予防的下大静脈フィルターを用いた肺塞栓症併存巨大な胃ｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌ　ｓｔｒｏｍａｌ　ｔｕｍｏｒの１手術例

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  • A Case of Vena Cava Filter for Gastrointestinal Stromal Tumor Complicated by Pulmonary Thromboembolism

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A 72-year-old woman with anorexia was suspected of abdominal phyma and admitted for detailed examination. Abdominal CT revealed a giant tumor with partial cystic changes compressing the stomach, pancreas, and spleen. Digestive tract endoscopy did not show any abnormalities in the gastric mucosa. Angiography showed that the phyma compressed the right gastric and gastric omental arteries in the lateral posterior direction, and splenic arteriography showed nutrient blood vessels from the branches of the splenic artery, that is, the short gastric artery, left gastric omental artery, and upper pole splenic artery. These findings suggested GIST, requiring surgery. Three days after angiography, dyspnea suddenly developed, and pulmonary blood flow scintigraphy confirmed bilateral pulmonary embolism. Before surgery, an inferior vena cava filter was inserted, and surgery was done under general anesthesia. The patient was managed without intraoperative or postoperative complications. In the present patient, angiography was considered an etiological factor; in patients with a history or risk of pulmonary embolism or deep venous thrombosis, however, an in-dwelling inferior vena cava filter may be useful for preventing perioperative pulmonary thromboembolism.

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