Suspected Gut-Origin Sepsis Following Pelvic Exenteration for Stage IIIB Cervical Cancer: A Case Report
DOI:
https://doi.org/10.59141/-.v8i2.542Keywords:
Gut-Origin Sepsis, Pelvic Exenteration, Cervical Cancer, Septic Shock, Multiple Organ Dysfunction SyndromeAbstract
Sepsis is a life-threatening condition that may develop after major surgical procedures, particularly in patients who experience massive hemorrhage, prolonged tissue hypoperfusion, and gastrointestinal barrier dysfunction. This case report describes suspected gut-origin sepsis in a 33-year-old woman with stage IIIB cervical cancer who underwent pelvic exenteration after incomplete chemoradiotherapy. The surgical procedure lasted 11.5 hours and was complicated by massive intraoperative blood loss of approximately 5,000 mL, requiring extensive blood transfusion and intensive postoperative support. After surgery, the patient developed septic shock, acute kidney injury, severe metabolic acidosis, and multiple organ dysfunction syndrome. Intensive care management included vasopressor therapy, mechanical ventilation, continuous renal replacement therapy (CRRT), broad-spectrum antimicrobial therapy, fluid management, and nutritional support. Although definitive evidence of bacterial translocation from the gastrointestinal tract was unavailable, the combination of extensive pelvic surgery, prolonged tissue hypoperfusion, elevated lactate levels, and persistent systemic inflammation suggested gastrointestinal barrier dysfunction and possible gut-origin sepsis. Despite aggressive multidisciplinary management, the patient experienced recurrent cardiac arrest and ultimately died on the tenth day of intensive care. This case highlights the importance of early recognition of gastrointestinal barrier dysfunction, timely hemodynamic resuscitation, appropriate source control, antimicrobial therapy, and comprehensive organ support in critically ill postoperative patients at risk of sepsis and multiple organ dysfunction.
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