Delayed Recognition of Evolving Sepsis Following Extended Resection of Perihilar Cholangiocarcinoma: A Perioperative Anesthetic Perspective
DOI:
https://doi.org/10.35790/5sctrd76Keywords:
perihilar cholangiocarcinoma; perioperative anesthesia; sepsis; multiple organ dysfunctionAbstract
Abstract: Perihilar cholangiocarcinoma is associated with high perioperative morbidity because chronic biliary obstruction may conceal an evolving systemic inflammatory process before overt sepsis becomes clinically apparent. We report an elderly patient presenting with progressive jaundice, generalized pruritus, dark urine, pale stools, and significant weight loss who underwent radical resection with biliodigestive reconstruction for a Bismuth-Corlette type I tumor. Despite stable preoperative hemodynamics, persistent leukocytosis, anemia, elevated neutrophil-to-lymphocyte ratio, severe hyperbilirubinemia, hypoalbuminemia, hyponatremia, markedly elevated erythrocyte sedimentation rate, and hypouricemia suggested limited physiological reserve and possible evolving sepsis. The intraoperative course was uneventful, and early postoperative recovery appeared satisfactory. However, approximately 112 hours after surgery, the patient developed circulatory collapse with hyperlactatemia and progressive multiple organ dysfunction despite intensive care management, resulting in death on the fifth postoperative day, although blood cultures were not obtained prior to antibiotic administration and no pathogen was microbiologically confirmed. This case highlights the importance of integrating serial laboratory trends with clinical assessment, alongside prompt microbiological sampling, to facilitate earlier recognition of evolving sepsis in high-risk hepatobiliary surgery
Keywords: perihilar cholangiocarcinoma; perioperative anesthesia; sepsis; multiple organ dysfunction
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