Rectus abdominis hemorrhage causing postoperative fever and elevated procalcitonin after laparoscopic radical resection for sigmoid colon cancer with incomplete obstruction:a case report
REN Peide
ZHAO Zhixun
CHENG Pu
ZHENG Zhaoxu
CHEN Haipeng
LIU Hengchang
Abstract：Objective To investigate the clinical manifestations,diagnostic process,and treatment strategies for unexplained postoperative fever and abnormally elevated procalcitonin(PCT)levels caused by rectus abdominis hemor-rhage following laparoscopic radical surgery for sigmoid colon cancer complicated with incomplete intestinal obstruction.Methods A retrospective analysis was conducted on the clinical data,surgical procedure,and diagnosis and treatment of postoperative fever in a patient admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences in Decem-ber 2024.The patient presented with sigmoid colon cancer complicated by incomplete intestinal obstruction.Results A 61-year-old male patient underwent laparoscopic radical resection for sigmoid colon cancer and prophylactic ileostomy due to incomplete intestinal obstruction.Twenty-four hours after surgery,while receiving routine prophylactic antibiotics(cef-triaxone sodium,1.0 g twice daily,IV infusion),the patient developed fever accompanied by markedly elevated PCT(>50 ng/mL).Blood cultures and drainage fluid cultures were obtained.Physical examination revealed a tender,red mass over the right lumbar region.Ultrasonography indicated multiple subcutaneous hematomas in the surgical area,confirmed by CT as a rectus abdominis hematoma.Treatment was adjusted to intravenous imipenem-cilastatin sodium and topical mu-pirocin ointment.Following this intervention,the patient's temperature normalized,PCT levels significantly decreased,and both blood and drainage fluid cultures returned negative.At the one-month follow-up,the skin erythema and swelling had completely resolved,and the patient recovered well.Conclusions Rectus abdominis hemorrhage can induce local-ized subcutaneous hematoma and tissue inflammation,resulting in postoperative non-infectious fever and abnormal PCT el-evation.Clinicians should remain vigilant for this uncommon cause of postoperative fever.Timely diagnosis,aided by physical examination and imaging,and targeted treatment are crucial to rapidly control the inflammatory response and im-prove patient prognosis.
Keywords：sigmoid colorectal cancerileostomypostoperative feverprocalcitoninsystemic inflammatory re-sponsesubcutaneous hematoma
Publication Date：2025-10-25
Online Publishing Date：2025-11-20(First online date of this platform, not the publication date of the document)
Pages：5( 14-18 )