Urological cause of deep vein thrombosis quickly reversible

Introduction: Venous thrombosis is the formation of blood clots in the deep or superficial veins and usually affects the veins of the pelvis, femoral veins or popliteal veins. Deep vein thrombosis occurs most frequently in people over 50 years of age and may be triggered by major surgery, malignant syndromes, trauma, extrinsic compression, and the diagnosis is rapidly confirmed by Doppler ultrasound of the venous axes. We present a case report of deep vein thrombosis caused by disten-ded urinary bladder in a patient with prostatic hyper-trophy. Venous stasis is accepted as a predisposing fac-tor for DVT as Virchow triad. Review of the literature recognizes a few cases

Methods: We present the case of a 52-year-old man, smoker, known with untreated arterial hypertension, prostate hyperplasia (90cc), bladder lithiasis operated 3 weeks before and suppressed postoperative bladder survey 1 week before the presentation. The patient is present 2 weeks after removal of the Foley s catheter probe for poor pain and edema of lower limb more acutely on the left, occurring approximately 24 hours prior admission, constipation, and abdominal meteo-rism progressively aggravated after discharge. On the physical examination is observed volume increase of left inferior limb with warm, cyanotic tegument, po-orly positive Homans sign, rhythmic cardiac sounds, no pathological murmurs, AP=140/100 mmHg, HR=85bpm, normal respiratory exam, mobile abdo-men with breathing, increased volume in the hypo-gastric area, spontaneously painless, painful at deep palpation in hypogastric area and oliguria of about 24 h. Resting electrocardiogram shows sinus tachycardia rhythm with a cardiac frequency of 105bpm, witho-ut pathological changes. Paraclinic is present the in-flammatory syndrome (Fibrinogen =439 mg/dl, raised retention products (Cr=12.68 mg/dl, Urea=267.10 mg/ dl), mild hepatic cytolysis, normal PSA, fPSA and posi-tive D-Dimers. Abdominal ultrasound presents bilate-ral grade 2 hydronephrosis and bladder globe without any other pathological changes. A Foley catheter was inserted and approximately 13 liters of normochromic urine is evacuated in 24 hours. The inferior venous Doppler examination revealed thrombosis of external saphenous venous on the right and thrombosis in 1/3 proximal left superficial femoral vein, the permeable venous system further. The echocardiographic exami-nation is completely normal.

Results: The patient receives treatment with unfracti-onated heparin, platelet antiplatelets calcium blockers and beta blockers. 24 hours after resumption of diure-sis, creatinine decreased significantly with normal va-lues at 48 hours, with improvement in venous sympto-matology, the disappearance of venous thrombus and improvement of digestive symptoms. The patient is discharged and receives treatment with oral anticoagu-lant for 30 days, beta blocker, an inhibitor of conversion enzyme, and prostate resection is performed. Clinical and paraclinical screening for neoplasms was negati-ve, and the remission of symptomatology after bladder evacuation suggests venous thrombosis as the cause of bladder compression.

Conclusions: Bladder distention is a rare cause of deep venous thrombosis and there are few cases reported in the literature and is not a classic risk factor. However, venous stasis is a predisposing factor for venous throm-bosis and important bladder distention may produce this event. Acute urinary retention with significant bladder distension is a common pathology, however, venous thrombosis caused by it is quite rare, and the cause for which it occurs in certain patients is not elu-cidated.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)