Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery - A case report -

Abstract

Vena cava syndrome is a condition presenting with various symptoms caused by central venous obstruction, which can be divided into superior vena cava (SVC) syndrome and inferior vena cava (IVC) syndrome [1]. Although IVC syndrome is not as well-known as SVC syndrome, IVC obstruction can lead to superficial venous dilation as well as abdominal and lower limb edema [2]. It can have a diverse presentation, ranging from no symptoms to bilateral lower limb edema, hypotension, and supine hypotensive syndrome [2,3].Laparoscopic surgery is widely used to operate on various abdominal organs. Because carbon dioxide gas is insufflated intra-abdominally and the patient's position is changed in order to obtain the required field of view, the anesthesiologist needs to be vigilant regarding changes in the patient's vital signs during surgery.Although case reports of perioperative SVC syndrome are common, perioperative IVC syndrome has been rarely reported [4,5]. Here, we present a case of sustained hypotension due to compression of the IVC by intrathoracic herniation of peritoneal fat during laparoscopic anterior resection, along with a review of the literature. CASE REPORTA 65-year-old man (height, 161 cm; weight, 81 kg) was scheduled for a laparoscopic anterior resection after being diagnosed as having sigmoid colon cancer. The patient had no specific history except for hypertension. Preoperative Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomyTrendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.

When Variants Collide: An Unusual Presentation of Metastatic Gastric Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm

“…We attributed her symptoms to IVC compression by extensive lymphadenopathy consistent with IVC syndrome, a presentation consistent with the literature. 6 – 8 A similar case of IVC compression has been described, eluding to the propensity of these tumors to metastasize in a disorganized way risking compression of vital structures. 7 …”

“…These tumors respond to platinum-based regimens, often administered for 4 cycles, while surgical metastasectomy offers no further benefit. 6 In a multinetwork cohort, platinumbased regimens demonstrated higher efficacy than folinic acid, fluorouracil, and irinotecan and folinic acid, fluorouracil, and oxaliplatin regimens for progression-free and median overall survival. Platinum-based therapy is highly individualized but often administered as cisplatin 25 mg/m 2 on days 1-3 or carboplatin 300 mg/m 2 followed by etoposide 100 mg/m 2 on days 1-3 every 21 days.…”