Surgical hypothermia and its postoperative challenges: A case report

Intraoperative hypothermia is a well-recognised complication in major surgical procedures, commonly resulting from prolonged operative times, exposure of large body surface areas, and the administration of cold intravenous fluids. Hypothermia is associated with several adverse effects, including coagulopathy, delayed wound healing, and impaired immune function. Although its systemic effects are well documented, haemorrhagic pleural effusion and compressive cervical haematoma have not previously been reported as complications attributable to hypothermia. Such consequences can significantly affect postoperative recovery and prolong hospitalisation. Evidence remains limited regarding intraoperative hypothermia during major surgeries such as oesophagectomy, particularly when it leads to localised bleeding that subsequently compresses vital structures.

We describe a case involving a 21-year-old male who developed significant intraoperative hypothermia during an oesophagectomy, with his core temperature falling to 34°C despite adherence to standard warming protocols. Postoperatively, he developed a haemorrhagic pleural effusion and a cervical haematoma, most likely secondary to hypothermia-induced coagulopathy. Impaired coagulation led to bleeding from the pulmonary microvasculature, resulting in the pleural effusion, while the same mechanism contributed to a neck haematoma that caused respiratory compromise and required emergency surgical intervention. These complications prolonged his recovery, leading to an extended stay in the Surgical Intensive Care Unit (SICU) and overall longer hospitalisation.

This case emphasises the potential of intraoperative hypothermia to cause rare but life-threatening complications by highlighting severe and under-recognised adverse effects such as haemorrhagic pleural effusion and compressive neck haematoma. The haemorrhagic pleural effusion observed in this patient suggests that hypothermia-induced coagulopathy can significantly compromise vascular integrity, leading to bleeding from microvessels within the pleural cavity. The development of a neck haematoma further highlights the need for early recognition and prompt management of bleeding complications in the postoperative period, particularly after major surgical procedures.This case also illustrates the limitations of current warming strategies and emphasises the need for more refined approaches to prevent intraoperative hypothermia during complex surgery.

This case highlights the multifaceted impact of intraoperative hypothermia, particularly its role in contributing to uncommon yet severe complications. It reinforces the importance of close temperature monitoring and early intervention for bleeding and resultant organ compression during the postoperative period, especially following major surgery. Further studies are needed to refine preventive strategies for intraoperative hypothermia and to enhance understanding of the mechanisms underlying these rare complications.