A 44-year-old white man presented to our institution in 2010 for an elective splenectomy after recurrence of splenosis, a condition characterized by regeneration of splenic tissues following previous splenectomies. The splenosis had resulted in refractory thrombocytopenia, leading to the patient's decision to undergo the surgical procedure.
The patient's medical history was notable for stage-1 lymphocyte-dominant Hodgkin lymphoma, which had been diagnosed in 2003 and had been in remission since initial radiation therapy. In 2007, he was diagnosed as having idiopathic thrombocytopenia purpura (ITP), leading to his first splenectomy. After this splenectomy, acute DVT (involving the left popliteal, left peroneal, and left soleal veins) developed in the patient, and he received anticoagulation with dalteparin sodium. In 2009, after his second splenectomy for splenosis, acute DVT (involving the left popliteal and left peroneal veins) again developed, and the patient was treated with low molecular weight heparin (LMWH).
In 2010, in preparation for the patient's third splenectomy, again for splenosis, a retrievable inferior vena cava (IVC) filter was placed. Use of LMWH continued until 2 days before surgery. An open splenectomy procedure was performed 15 days after IVC filter placement. Postoperatively, the patient was placed on heparin (5000 U subcutaneously every 12 hours) for “DVT prophylaxis.” On postoperative day 4, the patient complained of epigastric pain and persistent calf pain. He had a cardiopulmonary arrest several hours after these symptoms.
During the resuscitation attempt, 2-dimensional echocardiographic examination revealed multiple masses within the right atrium, consistent with pulmonary embolism and acute right ventricular dysfunction. Autopsy showed multiple, bilateral pulmonary embolisms. The IVC filter was located, with adherent thrombi. At death, the patient's platelet count was 156,000/μL.