Report on a patient with pre-existing venous thrombosis and incidental malignancy undergoing urgent laparotomy: preoperative concerns

Summary

The management of a patient with pre-existing deep venous thrombosis (DVT) who was subsequently found to have a malignancy planned for urgent laparotomy is reported.

A 30-year-old woman presented to the emergency room and was diagnosed to have a DVT. During work-up, she was found to have a malignanacy and was scheduled for urgent laparotomy. The patient was put on enoxaprin (injection) and warfarin (tablets). The patient was started on heparin (injection) 1000 IU/h at 72 h prior to operation, stopped 6 h prior to surgery. Anaesthesia and surgery were uneventful.

A number of issues related to pre-existing DVTs prior to gynaecological surgery require further clarification; the optimal duration of pharmacological treatment, and the optimal duration/modality of prophylaxis to prevent thromboembolism in high-risk patients with cancer.

Patients presenting for DVT must be evaluated for its causative factor(s), and malignancy in particular, based on clinical findings and investigations. Before planning surgical procedures, adequate anticoagulation must be achieved to prevent further complications of DVT, thromboembolism and pulmonary embolism in particular.