Fatal pulmonary thromboembolism after Achilles tendon open repair

RATIONALE The operative procedure for Achilles tendon rupture is relatively simple, but venous thromboembolism is serious complication with a high incidence after Achilles tendon rupture. However, the guideline for thromboprophylaxis in Achilles tendon rupture is unclear. PATIENT CONCERNS The patient was 32-year-old male and underwent Achilles tendon open repair surgery. He was healthy and there are no abnormal findings other than Achilles tendon rupture. At 3 weeks after operation, the episode of loss of consciousness with convulsive movement occurred. The next day, suddenly cardiac arrest occurred. DIAGNOSES Extensive pulmonary thromboembolism in both pulmonary arteries was identified in chest computed tomography and thrombus was also identified at the left popliteal vein on ultrasonography. INTERVENTION Anticoagulant therapy with heparin sodium was performed to manage the pulmonary thromboembolism. OUTCOMES Brain swelling after ischemic brain damage, acute kidney injury, and pneumonia gradually occurred and aggravated. His condition became worse and he died about 2 weeks after the cardiac arrest episode. LESSONS Although the incidence of venous thromboembolism in Achilles tendon rupture is higher than that in lower leg injury patients, guideline for thromboprophylaxis is unclear. We suggest that thromboprophylaxis for Achilles tendon rupture should be considered and appropriate guidelines should be established.