Anesthesia & Clinical Research
Open Access

When DVT turns into surgical catastrophe: Undiagnosed case of May-Thurner syndrome leading to retroperitoneal haematoma and fatal haemorrhage

Joint Event on 2^nd World Congress on Surgeons & 12^th International Conference on Anesthesiology and Critical Care

November 11-12, 2019 | Istanbul, Turkey

Jonathan Eley, Agilinko Joshua, Hasan Mohammad, McIntosh Stuart and Husain Najam

Aberdeen Royal Infirmary, UK
Queens Hospital, UK

Posters & Accepted Abstracts: J Anesth Clin Res

Abstract :

Introduction: May-Thurner Syndrome (MTS) is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or blood clots (deep venous thrombosis) in the left iliofemoral veins. MTS can present as acute or chronic Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE), chronic leg pain and chronic venous ulceration. It ranges from 18-49% in patients who present with a left lower extremity DVT. Spontaneous rupture of the iliac vein has few reported cases in the literature. Management is usually dependant on the severity of individual cases; conservative pharmacological anti-coagulation or catheterdirected thrombolysis followed by endovascular stenting. We would like to share a case of a 60-year-old female who presented with MTS.

Case: A 60-year-old Caucasian female was admitted with pain and unilateral swelling of the left leg of two days duration. Prior to admission the patient had no previous history of recent illness or surgery. Examination confirmed left lower limb swelling and additionally a mass was noted in the left iliac fossa. Baseline investigations including haemoglobin and haematocrit were normal. Arterial blood gas sampling showed a metabolic acidosis. After initial assessment the patient underwent cardiac arrest. After resuscitation an urgent CT abdomen and pelvis was organised. CT scanning confirmed a DVT of the left common iliac vein and a left adnexal mass. Post-operative review of imaging by a Vascular Radiologist suggested rupture of venous collaterals due to DVT in the left iliac vein, secondary to May-Thurner syndrome. The patient underwent exploratory laparotomy due to haemodynamic compromise. Intraoperative findings were of a large retroperitoneal haemorrhage with blood from the region of the left common iliac vein and collaterals. Post vascular control, the patient was transferred to intensive care. Unfortunately, the patient died within 24 hours due to multi-organ failure and disseminated intravascular coagulation secondary to massive transfusion.

Conclusion: Spontaneous rupture of the iliac vein is a vascular emergency that should be treated immediately. A high clinical suspicion and Computed Tomography play an important role in the correct pre-operative diagnosis. In middle-aged women presenting with left-sided retroperitoneal haematoma, deep vein thrombosis and leg swelling; the possibility of the rupture of the left common iliac vein should be considered. In cases with spontaneous rupture of the iliac vein associated with May-Thurner syndrome, endovascular prosthesis combined with surgery can be another therapeutic option with an excellent result for immediate cessation of extravasation and restoration of the venous patency.