Fatal retroperitoneal fungal abscess following surgery for gallbladder cancer: an autopsy case report

Infectious complications after biliary cancer surgery can be severe and fatal. Although fungal infections are uncommon, they have high mortality rates, particularly in older patients, those requiring intensive care, and those receiving prolonged broad-spectrum antibiotics. An 82-year-old man underwent gallbladder bed resection with regional lymphadenectomy for gallbladder cancer. Postoperatively, he experienced massive bleeding requiring repeated transarterial embolization, which caused progressive organ failure. Despite intensive care, including renal replacement therapy and antifungal treatment, the patient developed persistent sepsis and died on postoperative day 29. Drainage fluid cultures revealed Candida albicans, and serum β-D-glucan levels were markedly elevated. Autopsy revealed a massive retroperitoneal abscess caused by fungal infection, presumed to be Candida, without residual or recurrent malignancy. This case highlights that postoperative fungal infections, although rare, can have catastrophic outcomes following highly invasive biliary surgeries. Early suspicion of fungal infections and prompt intervention are crucial in older patients with multiple risk factors.