Painless colonoscopy of pelvic mass complicated with pulmonary embolism: a case report
盆腔占位无痛肠镜检查并发肺栓塞一例

摘要

临床上，盆腔占位患者行无痛肠镜检查术后并发急性肺栓塞的病例及其少见。本病例患者就诊时，直肠指检触及一质软包块，为明确包块情况，行无痛肠镜检查，术后发生心跳骤停，肺动脉造影示肺主动脉干及其分支多发充盈缺损，确诊肺动脉栓塞。在右肺动脉开口置入导管进行局部溶栓治疗，患者安全转综合ICU进一步治疗。该病例提醒我们对盆腔占位患者，要重视血栓形成三大危险因素中的血流瘀滞，警惕这类患者无痛肠镜检查围术期发生肺栓塞的风险，尤其是曾有下肢静脉血栓史的。盆腔占位患者行无痛肠镜前要围绕病灶进行有针对性的检查，提防肺栓塞的发生。

Abstract

Clinically, the cases of acute pulmonary embolism after painless colonoscopy in pelvic space occupying patients are rare. In this case, a soft mass was touched by digital rectal examination. In order to clarify the mass, painless enteroscopy was performed. Cardiac arrest occurred after operation. Pulmonary arteriography showed multiple filling defects in the pulmonary aortic trunk and its branches, and pulmonary embolism was confirmed. Catheters were placed at the opening of the right pulmonary artery for local thrombolysis, and the patient was safely transferred to comprehensive ICU for further treatment. This case reminds us that for patients with pelvic space occupying lesions, we should pay attention to blood stasis among the three risk factors of thrombosis, and be alert to the risk of pulmonary embolism during painless enteroscopy, especially those who have a history of lower extremity venous thrombosis. Before painless enteroscopy, pelvic space occupying patients should have targeted examination around the focus to prevent the occurrence of pulmonary embolism.