Brachial Vein Thrombosis Following Abdominal Hysterectomy and Hernioplasty under General Anaesthesia: A Case Report

Upper Extremity Deep Vein Thrombosis (UEDVT) is a relatively rare but serious postoperative complication. While lower limb thrombosis is more common after major pelvic surgery, UEDVT, such as brachial vein thrombosis, can occur and poses significant diagnostic and therapeutic challenges. A 46-year-old female presenting with a fibroid uterus and umbilical hernia underwent an uneventful total abdominal hysterectomy, bilateral salpingo-oophorectomy, and hernioplasty under general anaesthesia. Intraoperatively, standard monitoring was used with an intravenous line secured in the right arm. Six hours postoperatively, the patient developed acute pain, swelling, and bluish discolouration of the left hand, which was unresponsive to analgesics. Although peripheral pulses were palpable and a hand X-ray was normal, a venous duplex ultrasound of the left arm confirmed a brachial venous thrombus. No signs of Pulmonary Embolism (PE) were present. The patient was immediately treated with an intravenous Unfractionated Heparin (UFH) infusion for 24 hours, followed by subcutaneous heparin for three days. Her symptoms resolved within 72 hours, and she was transitioned to oral apixaban. Complete resolution of the clot was confirmed via ultrasound at a 3-month follow-up, and anticoagulation was safely discontinued. This case underscores the importance of maintaining a high index of suspicion for UEDVT in the early postoperative period, even in asymptomatic limbs without direct vascular intervention. Prompt diagnostic ultrasound and immediate anticoagulation are critical to managing upper extremity thrombi and preventing thromboembolic complications.