Heparin
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Anastomotic bleeding: case report A 63-year-old man developed anastomotic bleeding during intraoperative anticoagulation with heparin. The man presented with an abnormal lesion in his oesophagus after upper gastrointestinal screening. He also had a history of deep vein thrombosis due to protein C deficiency and had been treated with edoxaban [edoxaban tosilate hydrate]. Following examinations, he was diagnosed with stage I squamous cell carcinoma of the oesophagus (T1bN0M0). He underwent a thoracoscopic oesophagectomy and digestive reconstruction without intra-operative anticoagulation management. However, he developed anastomotic leakage and gastric tube necrosis requiring cervical oesophagostomy and intrathoracic drainage. After 140 days of the first surgery, digestive reconstruction with a free jejunal graft was planned but failed owing to thrombus formation in the artery and vein of the jejunal graft. After 10 days, he underwent digestive reconstruction using the pediculate colon and anticoagulation control of activated coagulation time (ACT). His ACT maintained over 200 seconds by administration of heparin [route and dosage not stated]. His digestive reconstruction was successful without formation of thrombus. However, after surgery, his ACT showed significant prolongation and he developed anastomotic bleeding 2 hrs after the surgery. The man required surgical haemostasis for the bleeding. After the bleeding episode, heparin administration was strictly managed and his ACT was maintained at 120–150 seconds. After the surgery, he was discharged within 14 days. At a follow-up one year later, he was alive without signs of recurrence. Ujiie N, et al. Esophagectomy for Esophageal Cancer in a Patient with Protein C Deficiency: A Case Report. Annals of Thoracic and Cardiovascular Surgery: Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 26: 286-289, No. 5, 12 Oct 2020. Available from: URL: http://doi.org/10.5761/ 803520076 atcs.cr.20-00129
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Reactions 12 Dec 2020 No. 1834
