Disseminated intravascular coagulation after cryoablation for metastatic pancreatic cancer: A case report Journal Article
| Authors: | Dulu, A.; Tayban, Y.; Delaleu, J.; Cornelis, F. H.; Pastores, S. M. |
| Article Title: | Disseminated intravascular coagulation after cryoablation for metastatic pancreatic cancer: A case report |
| Abstract: | Background: Pancreatic cancer is the fourth most common cause of cancer-related death in the United States. Despite advancements in surgery and chemoradiation therapies, pancreatic cancer has a 5-year survival rate of only 11% in the United States. Cryoablation is emerging as a new and effective therapy for locally advanced pancreatic cancer and symptom palliation in metastatic disease. To our knowledge, the occurrence of disseminated intravascular coagulation (DIC) after cryoablation is rare. Case Description: A 47-year-old woman with no significant past medical history was diagnosed with pancreatic cancer and underwent a Whipple procedure followed by chemotherapy with gemcitabine and paclitaxel. Due to the abdominal lymph nodes, peritoneum, right femur, and surrounding soft tissue metastases, she received systemic palliative chemotherapy with gemcitabine and paclitaxel and underwent right femur tumor excision, open reduction, and internal fixation, followed by radiation therapy. She continued to have persistent pain and underwent palliative percutaneous cryoablation of the metastatic tumor under computed tomography (CT) and ultrasound guidance. Immediately post procedure, she developed slow but continuous blood oozing at the ablation site, which was difficult to control despite compression dressings, reinforcement sutures, and local thrombin powder. The patient was transferred to the intensive care unit where she was noted to be hypotensive and tachycardic, with petechiae in both lower extremities. Laboratory studies were consistent with DIC and peripheral blood smear revealed multiple schistocytes. CT angiogram of the right lower extremity did not show any bleeding vessel amenable to embolization. She was transfused red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. Despite multiple daily transfusions, she continued to have pain and remained persistently thrombocytopenic and coagulopathic. After discussion with the patient and her family, she chose to transition to comfort care measures and died. Conclusions: DIC is an unusual but life-threatening complication of advanced pancreatic cancer. © AME Medical Journal. All rights reserved. |
| Keywords: | adult; cancer chemotherapy; clinical article; middle aged; cancer surgery; osteosynthesis; case report; drug withdrawal; systemic therapy; treatment duration; bone metastasis; gemcitabine; paclitaxel; cancer radiotherapy; pancreas cancer; drug megadose; lymph node metastasis; paraaortic lymph node; pancreaticoduodenectomy; quality of life; computer assisted tomography; anemia; thrombocytopenia; opiate; deep vein thrombosis; device removal; ultrasound; hypotension; liver failure; intensive care unit; laboratory; clinical decision making; chronic pain; blood clotting disorder; cryoablation; erythrocyte transfusion; leg pain; tachycardia; computed tomographic angiography; blood smear; thrombocyte transfusion; narcotic agent; thrombin; rivaroxaban; hospice care; soft tissue metastasis; repeat procedure; medical history; cryoprecipitate; petechia; pancreas metastasis; fresh frozen plasma; international normalized ratio; plasma transfusion; image guided radiotherapy; comfort; disseminated intravascular clotting; palliative chemotherapy; powder; life threat; human; female; article; artificial embolization; disseminated intravascular coagulation (dic); pancreatic cancer (pc); application site bleeding; femoral metastasis; open reduction (procedure); schistocyte |
| Journal Title: | AME Medical Journal |
| Volume: | 8 |
| ISSN: | 2520-0518 |
| Publisher: | AME Publishing Company |
| Date Published: | 2023-06-30 |
| Start Page: | 17 |
| Language: | English |
| DOI: | 10.21037/amj-23-13 |
| PROVIDER: | scopus |
| PMCID: | PMC11141771 |
| PUBMED: | 38827122 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Stephen M. Pastores -- Source: Scopus |
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