Abstract
A 74-year-old man with the chief complaint of dysphagia was diagnosed as having esophageal cancer and was admitted to the hospital for surgery. He had a good appetite and no underlying disease. Preoperative hematology and a respiratory function test revealed no abnormality. An esophagectomy and reconstruction using a gastric tube via the posterior mediastinal route was performed with 3-field lymph node dissection. The estimated blood loss amounted to 2, 810ml. Intraoperatively, 1, 200ml of autologous blood and homologous blood (5 units of MAP and 14 units of FFP) were transfused. Immediately after surgery, the WBC count was remarkably low, 1, 600/μl. Administration of G-CSF and anticytokine was immediately started, but hypoxemia occurred on the 2nd day after surgery. Although steroid pulse, high-frequency jet ventilation and NO inhalation therapy were performed, the patient died due to respiratory failure on the 6th day after surgery. On autopsy multiple massive abscess formations with a great volume of pus were identified in the bilateral lungs. We believe that high levels of WBCs accumulated in the lung parenchyma intraoperatively and that accumulation led in this case to serious pneumonia.
