A Case of Surgical Drainage for Intra-abdominal Candidiasis after Peritonitis due to a Perforated Duodenal Ulcer

Abstract

Intra-abdominal candidiasis (IAC) is a rare postoperative complication with a poor prognosis. We report a case of surgical drainage of multiple intra-abdominal abscesses after emergency surgery for peritonitis secondary to a perforated duodenal ulcer. A 65-year-old man with peritonitis and septic shock due to a perforated duodenal ulcer underwent emergency laparotomy. Postoperatively, although the patient recovered from septic shock, fever and CRP re-elevation were observed on the sixth postoperative day. Since Candida albicans was identified in the infectious ascites collected during surgery, an antifungal agent was administered. Symptoms such as fever did not improve 10 days after surgery. Abdominal contrast-enhanced CT showed numerous intra-abdominal abscesses. Hence, surgical drainage was performed. Postoperatively, intestinal fluids flowed out of the perforated duodenal ulcer. The antifungal agent was continued for 28 days, during which the IAC improved. Surgical drainage is essential for the treatment of IAC after emergency surgery. However, relaparotomy is highly risky, and further studies on the appropriate timing and indications are required.