Postoperative anastomotic embolism and elusive chronic nausea following pulmonary artery tear during single-port thoracoscopic lobectomy: a case report and examination of potential mechanisms

This paper details the diagnosis and treatment of a 66-year-old male patient with invasive adenocarcinoma in the left upper lobe of the lung, who experienced a pulmonary artery injury during a single-port thoracoscopic lobectomy. During surgery, the basal trunk artery’s root was torn due to enlarged lymph nodes encircling the pulmonary artery, necessitating an urgent conversion to thoracotomy for end-to-end anastomosis and reconstruction of the artery. Eighteen hours post-operation, the patient unexpectedly developed atrial fibrillation. A CTA scan confirmed an embolism in the left pulmonary basal trunk artery, leading to the administration of low-molecular-weight heparin and rivaroxaban for anticoagulation. Nausea recurred during this treatment, persisting for 12 months before resolving spontaneously upon cessation of the medication. Follow-up imaging indicated the embolism remained, though collateral circulation was compensating effectively. This case underscores the importance of devising an individualized vascular reconstruction strategy for managing complex pulmonary artery injuries, emphasizing the necessity of selecting the optimal repair method during surgery. New-onset atrial fibrillation post-surgery should be considered a potential indicator of pulmonary embolism, warranting prompt imaging evaluation. Furthermore, managing anticoagulant-related nausea is notably complex, potentially influenced by factors such as adverse drug reactions and abnormal neuroimmune responses triggered by embolic events. This study offers significant clinical insights into managing rare long-term complications following VATS.