Acute respiratory distress and hemorrhagic shock in a patient 12 days after elective hepatic surgery

Excerpt

A 69-year-old woman was admitted to the Surgical Department for elective cholecystectomy and enucleation of a large hepatic hemangioma. Her past medical history was unremarkable and her initial laboratory tests were normal. The patient received peri-operatively ceftriaxone and postoperatively low-molecular-weight heparin for venous thrombosis prophylaxis. Her post-operative course was uneventful. On the 12th postoperative day, the patient exhibited acutely, respiratory distress, tachycardia and abdominal pain while her blood pressure dropped significantly (systolic blood pressure < 90 mmHg) with a concomitant decrease in hemoglobin (Hb) from 10.5 g/dl to 7 g/dl. The clinical examination revealed considerable abdominal distension and tenderness and absence of bowel sounds. The blood pressure did not respond to rapid infusion of blood products and fluids, and the patient's condition was rapidly deteriorating. …