DIC after abdominal operation. Report two cases

Abstract

Case 1: A 28-year-old male was admitted to the hospital complaining of abdominal pain. Since 13 years old, he had been suffering from superficial and deep venous thrombophlebitis of the lower extrimities. Examinations on admission suggested mesenteric venous thrombosis and laparotomy was performed. As a segment of terminal ileum was necrotic, the involved bowel of 105cm in length and its mesentery were resected and a side-to-side anastomosis restored intestinal continuity.Postoperative recovery was uneventful except fever of 38°C during 23-25 postoperative day. On the 31st day, laboratory examinations revealed fibrinogen was 60mg/dl, prothrombin time more than 60 seconds and platelets count 140, 000 suggesting intravascular coagulation. Heparin was administrated for 3 days until intestinal bleeding began. Despite of transfusion of blood of 4, 300ml for 5 days, hemoglobin decreased to 6.6mg/dl. At that time, clotting time was 6 minutes and whole blood resolution time was 30 minutes, which suggested hypercoagulation and hyperfibrinolysis. After re-administration of heparin, melena subsided and clinical & laboratory findings recovered well. Heparin was changed to warfarin further to aspirin later. During his admission, in spite of positive RA test and high level of gamma globulin, there were no evidence of collagen diseases. Gynecomastia was noted and estrogen value in urine showed 3 times higher than normal.Case 2: A 41-year-old male. He underwent total gastrectomy for scirrhus gastric cancer. The postoperative course was uneventful until melena occurred on the 13th postoperative day. Purpura was noticed and laboratory examinations revealed fibrinogen was 50mg/dl, prothrombin time 16 seconds and platelets count 50, 000. FDP was, however, negative. Administration of heparin improved clinical and laboratory findings. Bone marrow puncture showed metastatic cancer cells. 73 days after the operation, he expired due to cerebral bleeding.In these 2 cases, clinical findings, hemorrhagic diathesis, low fibrinogen value and prolonged prothrombin time suggested DIC syndrome improved by administration of heparin. Although tne operative injury is one of the important causative factors of DIC, owing its influence upon coagulation-fibrinolysis system through endcrine reactions, disturbance of local blood flow and so on, the postoperative course of these two cases was both uneventful throughout the convalescent period. Accordingly, it could be assumed that operative injury played little role to the occurrence of DIC in these cases. Otherwise, the basic diseases, recurrent thrombophlebitis in one and metastatic cancer cells in bone marrow in another, might be regarded as a cause of DIC.