Intraoperative Disseminated Intravascular Coagulation During Thoracolumbar Decompression in a Patient With Metastatic Carcinoma of the Prostate: Etiology, Diagnosis, and Treatment

Various factors may be responsible for disturbances of coagulation function during the perioperative period. Disseminated intravascular coagulation or coagulopathy (DIC) results from the widespread activation of the clotting cascade on the endothelial surface throughout the microvasculature that results in the formation of thrombin and fibrin. Although an uncommon cause of intraoperative bleeding, previous reports have noted the occurrence of DIC in association with adenocarcinoma of the prostate. We present a 62-year-old man with known metastatic carcinoma of prostate, who presented with rapidly progressing paraplegia and incontinence. During an emergent posterior thoracolumbar decompression and instrumentation, he developed excessive blood loss and DIC. The potential etiologies for intraoperative DIC are reviewed, the diagnosis is discussed, and perioperative management strategies are presented. J Med Cases. 2015;6(9):426-429 doi: http://dx.doi.org/10.14740/jmc2264w