Asymptomatic pulmonary thromboembolism diagnosed based on prolonged fever after gastric cancer surgery: A case report with literature review.

Introduction: Venous thromboembolism (VTE) is a serious postoperative complication with potentially fatal outcome. However, asymptomatic VTE is difficult to diagnose and is often discovered by chance. We report a case of suspected VTE diagnosed based on prolonged fever after surgery and discuss the literature.

Presentation Of Case: A 48-year-old man was referred to us with a diagnosis of gastric cancer. Upper gastrointestinal endoscopy revealed a neoplastic lesion from the anterior wall of the mid-gastric mass to the upper part of the gastric body, and biopsy revealed adenocarcinoma. Contrast-enhanced computed tomography (CT) showed no obvious distant metastasis. The preoperative diagnosis was gastric cancer, cT4aN1M0 cStage III, and radical surgery was performed. During surgery, an intermittent pneumatic compression pump was used. Subcutaneous injection of enoxaparin was started postoperatively. A high fever continued on postoperative day 4, and high D-dimer level of 14.3 μg/mL was found. Contrast-enhanced CT scanning showed thrombus in the left upper lobe pulmonary artery A4/5. Lower extremity venous ultrasonography revealed a thrombus in the right soleal vein, and apixaban 20 mg/day was started that day. Thereafter, fever resolved quickly, and the D-dimer level gradually decreased. The patient was discharged from hospital on day 21 having made good progress.

Discussion: It sould be rememberd that there are VTE found in persistent fever after gastric cancer surgery. The main complaint was simply fever, and the fever disappeared with anticoagulant.

Conclusion: This cases suggests the importance of perioperative measures against VTE. Peri operative treatment with apixaban was safe and effective.