Acute Intraoperative Disseminated Intravascular Coagulation During Suppurative Keloid Excision: A Case Report

BACKGROUND Disseminated intravascular coagulation (DIC) is a severe coagulopathy characterized by widespread microvascular thrombosis and consumptive coagulopathy, leading to both thrombosis and hemorrhage. Whereas DIC is well documented in sepsis, trauma, and malignancy, its occurrence during surgery - particularly in the context of chronic inflammation and localized infected wounds - is exceedingly rare. CASE REPORT Acute intraoperative DIC occurred in a 62-year-old woman during suppurative keloid excision. The patient had a history of recurrent keloids with chronic inflammation but no prior coagulopathy, and preoperative coagulation test results were normal. During the procedure, she developed excessive bleeding; postoperative laboratory results showed prolonged prothrombin time, low fibrinogen and platelet levels, and substantially elevated D-dimer, confirming DIC based on the International Society on Thrombosis and Haemostasis criteria. The patient received multimodal treatment, including aggressive blood product transfusion (fresh frozen plasma, cryoprecipitate, and platelet concentrate), broad-spectrum antibiotics (meropenem and daptomycin) targeting a presumed deep-seated infection, and continuous renal replacement therapy for acute kidney injury. Coagulation parameters improved within 14 hours; the patient achieved full recovery from the DIC episode and its acute complications. CONCLUSIONS This case highlights the potential for acute intraoperative DIC in patients with chronic inflammatory conditions and underscores the importance of early recognition, intraoperative coagulation monitoring, and a multidisciplinary management approach. Timely adherence to international DIC management guidelines may substantially improve patient outcomes in such rare but life-threatening scenarios.