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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

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A mysterious postoperative rash.

Maria Chicco¹, George Filobbos², Nicholas Francis³

¹Department of General Surgery, Imperial College Healthcare NHS Trust, London, UK.

BMJ Case Reports

|May 17, 2018

Summary

This summary is machine-generated.

A patient developed a severe rash and low platelet count after surgery for colon cancer. This was diagnosed as heparin-induced skin necrosis, prompting a switch in medication to prevent further complications.

Keywords:

drug therapy related to surgery skin unwanted effects / adverse reactions

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Area of Science:

Medical Case Reports
Dermatology
Oncology

Background:

Large bowel obstruction due to sigmoid colon carcinoma requires surgical intervention.
Postoperative complications can include adverse drug reactions.
Heparin-based anticoagulants are commonly used for prophylaxis.

Observation:

On postoperative day 3, the patient presented with a bullous hemorrhagic rash on the thighs, flanks, and abdomen.
A significant drop in platelet count was noted concurrently with the rash development.

Findings:

Clinical suspicion for heparin-induced skin necrosis was raised due to the characteristic rash and thrombocytopenia.
Skin biopsy confirmed heparin-induced skin necrosis, a serious adverse effect of heparin-based anticoagulants.
The prophylactic enoxaparin was switched to fondaparinux upon suspicion of the diagnosis.

Implications:

Early clinical suspicion and prompt management are crucial for mitigating severe complications of heparin-induced skin necrosis.
Switching to an alternative anticoagulant, such as fondaparinux, is essential to prevent disease potentiation.
This case highlights the importance of recognizing and managing heparin-induced skin necrosis in surgical patients receiving anticoagulation therapy.