山东医药2025，Vol.65Issue(10)：14-18,5.DOI:10.3969/j.issn.1002-266X.2025.10.003
乙状结肠癌合并不完全性肠梗阻腹腔镜根治术后腹直肌出血致发热及降钙素原异常升高1例
Rectus abdominis hemorrhage causing postoperative fever and elevated procalcitonin after laparoscopic radical resection for sigmoid colon cancer with incomplete obstruction:a case report
摘要
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.关键词
乙状结肠癌/回肠造口/术后发热/降钙素原/全身炎症反应/皮下血肿Key words
sigmoid colorectal cancer/ileostomy/postoperative fever/procalcitonin/systemic inflammatory re-sponse/subcutaneous hematoma分类
临床医学引用本文复制引用
任培德,赵志勋,程璞,郑朝旭,陈海鹏,刘恒昌..乙状结肠癌合并不完全性肠梗阻腹腔镜根治术后腹直肌出血致发热及降钙素原异常升高1例[J].山东医药,2025,65(10):14-18,5.基金项目
国家自然科学基金项目(82473407) （82473407）
北京市朝阳区科技计划项目(CYSF2223). （CYSF2223）
