Hyperthermia Associated with Rhabdomyolysis Developing after an Operation for Traumatic Perforation of the Small Intestine and Generalized Peritonitis: A Case Report

Abstract

A 43-year-old man sustained a hard blow to his abdomen when playing volleyball and was rushed to the emergency outpatient clinic of our hospital. Computed tomography showed massive ascites and free intraperitoneal air, and the patient was diagnosed as having generalized peritonitis caused by traumatic perforation of the gastrointestinal tract. Emergency surgery was performed on the day of admission. A small perforation, about 1 cm in diameter, was found in the jejunum; the perforated site was resected and the anastomosis was performed. Sedation was provided by intravenous infusion of fentanyl and propofol after the operation. The patient became notably febrile (body temperature, >38℃) on the 2nd postoperative day and was treated for infection. However, his temperature increased to 41.1℃ on the 7th postoperative day, and therefore, fentanyl and propofol were discontinued. After the administration of cyproheptadine and extracorporeal cooling, his body temperature decreased to 37.5℃ in 6 hours. The patient was concomitantly given dantrolene. Rhabdomyolysis developed concurrently, requiring hemodialysis, but no high fever occurred. Thereafter, the patient's condition improved and he was discharged from the hospital. The clinical course was like the serotonin syn-drome.