Intraoperative Thrombose der V. cava inferior

Zusammenfassung

Bei einem 900 g schweren Frühgeborenen der 25. SSW wurde wegen einer Ileumperforation eine Ileumteilresektion mit Dünndarm-Anus praeter durchgeführt. Intraoperativ ergaben sich Probleme von seiten eines nicht korrigierbaren Volumendefizits. Venöse Zugänge befanden sich in der linken (Silastik-Katheter) und rechten (24G Kanüle) V. saphena. Bei faktischem Kreislaufstillstand mußte der Eingriff unter extrathorakaler Reanimation beendet werden. Nach dem Abdecken imponierten livide gestaute Beine, die den Verdacht einer frischen Thrombose der V. cava inferior bestätigten. Nach Anlegen einer Venenverweilkanüle an der oberen Extremität konnte nach adäquatem Volumenersatz innerhalb kurzer Zeit die Reanimation beendet werden.

Abstract

A pre-term infant weighing 900 g, gestational age 25 weeks, developed an acute abdomen. Intravenous lines had been inserted previously in the left (silasticcatheter) and right (24 G cannula) saphenous veins in the neonatal intensive care unit. During surgical exploration, a perforation of the terminal ileum was found. The operation consisted in partial resection of the perforated ileum with an end-to-end anastomosis and a double-lumen colostomy. Major blood loss during the procedure caused serious haemodynamic problems. Despite transfusion of erythrocyte (100 ml), thrombocytes (75 ml), and albumin (50 ml), the patient developed bradycardia and hypotension. Administration of atropine, adrenaline, and calcium IV had no effect. The operation could be finished only with extrathoracic resuscitation. When the drapes were removed, livid, swollen lower limbs raised the suspicion of an acute thrombosis of the inferior vena cava. After insertion of a 24 G IV cannula into a vein of the right upper arm, the circulation stabilised after rapid transfusion of 40 ml blood and 25 ml thrombocytes and resuscitation was successful. Paediatricians and anaesthesiologists must consider the risk of thrombosis of the vena cava. If venous lines in the lower limbs are not visible to the anaesthesiologist during the operation, venipuncture of veins of an upper limb is recommended before starting the surgical procedure. Due to the high incidence of vena cava thrombosis caused by central venous lines and the difficulty of peripheral venipuncture in pre-termintanty, a safe venous line should be inserted if necessary by pre-operative venesection.