Unexpected Takotsubo Cardiomyopathy Revealing Postoperative Intra-Abdominal Sepsis: A Case Report

Takotsubo cardiomyopathy (TTC) is a transient form of left ventricular dysfunction, typically precipitated by intense physical or emotional stress. We report a case in which TTC developed during the postoperative recovery phase and revealed occult intra-abdominal sepsis after surgery for generalized peritonitis.

A man in his 60s underwent emergency surgery for generalized peritonitis caused by cecal perforation associated with ascending colon and rectal cancer. Although his postoperative course initially stabilized, diffuse ST-segment elevation and apical hypokinesis developed on POD 5, and TTC was diagnosed. Contrast-enhanced CT showed no definitive evidence of intra-abdominal infection. However, the atypical timing of TTC onset, in conjunction with worsening inflammatory markers and persistently elevated vasopressor requirements, collectively prompted reassessment for an occult surgical complication. Exploratory laparotomy revealed perforation of the rectal stump with an intra-abdominal abscess, and surgical drainage was performed. After reoperation, the patient's respiratory and circulatory status improved and cardiac function recovered.

When unexpected TTC develops during postoperative management, the possibility of underlying surgical complications should be considered.