Abstract
We present a case of a 79-year-old woman with history of rectal adenocarcinoma, previously
submitted to an anterior resection in 2014. In June 2019, she was admitted in the Emergency
Department complaining of exuberant oedema of the left lower limb and progressive onset
prostration. At admission, she was responsive to painful stimuli, hypotensive and showed
marked left lower limb swelling with crepitation to palpation. The arterial blood gas analysis
evidenced metabolic acidosis and hyperlactacidemia. Analytical results included elevation of
systemic inflammatory markers and acute kidney injury AKIN 3. ECG and transthoracic
echocardiogram showed no alterations. Thoracic, abdominal, pelvic, and left lower limb CT
images documented an intestinal suture dehiscence and a gas collection located anteriorly to
the sacrum, as well as soft tissue emphysema in the left thigh, extending from the abdominal
wall to the left knee, involving the subcutaneous cellular tissue and multiple muscular
compartments. After a multidisciplinary-team meeting, it was decided to institute conservative
treatment measures. The patient progressed to multiorgan failure and died shortly after.
Suture dehiscence and consequent intestinal content leakage is the main cause of death after
colon surgery. (1) The most frequent complications are haemorrhage, ileus, and septic shock.
(2) Signs and symptoms usually appear between the third day up to several weeks after
surgery and its differential diagnosis with other post-operative infections may be challenging
when only based on clinical evaluation. (1) The presentation of asymmetrical lower limb
oedema and post-operative timing could have been confounding factors in this case. With this,
the importance of a thorough clinical and past medical history taking is evidently rooted in an
internist’s daily practice.
© 2022 Galicia Clínica.
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