Diffuse Intravascular Coagulation After A Shoulder Arthroscopic Surgery For Rotator Cuff Tear: A Case Report And Literature Review

Background: Shoulder arthroscopic surgery is considered to be the standard surgery for rotator cuff tear (RCT) as it has the advantages of being minimally invasive with less trauma, less bleeding, and faster recovery. The incidence of complications increases as the complexity of shoulder arthroscopic surgery increases. Disseminated intravascular coagulation (DIC) is a disease caused by systemic activation of coagulation, which will finally develop into multiple organ dysfunction. This case is rare as the DIC seldom happens in a RCT operation. We retrospectively analyzed the data in order to explore the clinical characteristics, diagnosis and treatment methods of DIC before and after shoulder arthroscopic surgery. Case presentation: A 60-year-old female patient was admitted to the hospital for RCT and underwent an arthroscopic surgery. Her intra-operative operation was successful without unexpected episodes. However, the patient suffered from massive postoperative bleeding due to DIC. A series of treatments of anticoagulation, alternative therapy, shock prevention, and microcirculation improvement were given. The patient's condition went back to stable and she was discharged on the 20th day postoperatively. Conclusion: For patients with abnormal coagulation function before the arthroscopic operation, the supplementation of fibrinogen to a normal value is recommended. Patients with recurrent and massive bleeding after surgery should routinely be checkedfor DIC to achieve an early treatment. Once postoperative DIC was found, immediately coagulation function and risk of thrombosis should be assessed, and the proper treatment should be applied to stabilize the patient's vital signs to prevent hemorrhagic shock.