Thrombosis of the abdominal aorta of a patient with tubal carcinoma undergoing Cytoreductive surgery under general anesthesia

A 74 year old patient, weighing 94 kg, with abdominal distention was admitted to hospital. Her upper and lower abdominal tomography was normal and ultrasonography could not be evaluated optimally because of massive ascites. She had undergone tumor debulking surgery (total abdominal hysterectomy, bilateral salphingo-oophorectomy, total omentectomy, appendectomy, pelvic and paraaortic lymph node dissection) under general anesthesia with prophylaxis for deep vein thrombosis. Pathologic examination revealed tubal carcinoma. At the end of the five hour long operation, the patient was admitted to the ICU for postoperative care. Within hours, progressive coldness and cyanosis bilaterally in the lower extremities were noted in her physical examination. Pulses distal to the femoral arteries were not palpable. Motor and sensory deficits were also present in both of the lower legs in her neurological examination. In her angiography, the aorta was atherosclerotic and a large thrombus, occluding the abdominal aorta, 3 cm distal to renal arteries, was revealed. The patient was taken for emergency embolectomy and treatment for hyperkalemia was also begun. After embolectomy, emergency hemodialysis was planned. However, the patient arrested in ICU and did not respond to cardiopulmonary resuscitation. Aortic thrombosis is a very rare and fatal complication after gyneco-oncologic surgery. Preoperative evaluation and assessment of risk factors should be done carefully and without losing time, since treatment options are very limited in such patients.