What happened, in summary

This 55-year-old woman had been diagnosed with rectal cancer 3 months before the main hospitalization, after perianal pain and rectal bleeding led to evaluation at another hospital. She underwent surgical resection for the rectal cancer, but her postoperative course was complicated by repeated intestinal obstruction. She had several admissions for obstruction and was managed conservatively each time. She later came to the hospital with 1 month of recurrent colicky abdominal pain, bloating, nausea, vomiting, and constipation. Her history also included cholelithiasis treated by cholecystectomy. After admission, her condition worsened quickly, with hypotension, electrolyte imbalance, and fever. Conservative management was ineffective, so urgent laparotomy was performed. Blood cultures were obtained, wound secretions were cultured during surgery, empiric antibiotics were started, and she was moved to the intensive care unit. In the ICU, she required phenylephrine for low blood pressure and had signs of severe intra-abdominal infection. She developed multiple organ dysfunction involving the circulatory, hematologic, renal, and hepatic systems. Treatment included continuous renal replacement therapy, fluids, vasoactive medications, blood transfusions, and broad-spectrum antibiotics. Initial blood cultures did not grow bacteria. On postoperative day 8, wound culture grew Enterococcus gallinarum, a Group D organism with intrinsic resistance to vancomycin and several other agents but susceptibility to selected alternatives. Antibiotics were changed to levofloxacin plus meropenem, then later de-escalated to levofloxacin and aztreonam. Her temperature normalized, infection markers returned to normal after 1 week, antibiotics were eventually stopped, and she was discharged after clinical improvement. Her course therefore centered on a life-threatening postoperative complication after rectal cancer surgery and recovery after targeted antibiotic adjustment.