Complications

Chronic subdural hematoma (CSDH) in frail older adults is increasingly recognized as a sentinel event, with mortality often driven by medical complications rather than neurosurgical factors. We report a failure-to-rescue case in which rapid postoperative deterioration occurred after burr-hole drainage for bilateral CSDH in a frail older adult with diabetes. A clinical picture consistent with sepsis was suspected, and a gastrointestinal source was considered, but the infectious focus could not be confirmed due to limited diagnostic work-up. On admission, chest-computed tomography showed mild right lower-lobe pneumonia, and incidental transverse colonic dilatation was also visible. Burr-hole drainage was uneventful and oxygenation rapidly normalized on room air. On postoperative day (POD) 3, the patient developed a high fever (39 °C), rising C-reactive protein (CRP; 14 mg/dL), abrupt leukopenia (15,300 → 3300/µL), and, several hours later, profuse watery diarrhea. At that time, an evaluation for an infectious source and escalation of therapy (e.g., blood cultures, serum lactate, and abdominal imaging) were not performed. In the early hours of POD 4, he suffered sudden desaturation, shock, and cardiac arrest, and died despite resuscitation. A portable radiograph after intubation showed no new diffuse pulmonary infiltrates but marked colonic gas distension. This case highlights the need to reassess diagnostic framing when discordant postoperative “red flags” emerge and proposes practical triggers for early sepsis evaluation and escalation—prioritizing early recognition and timely rescue rather than a definitive determination of the cause of death—in high-risk CSDH patients.

Carotid paragangliomas are rare neuroendocrine tumors that, despite being typically benign, present significant surgical and anesthetic challenges. This manuscript outlines the anesthetic management for surgical resection, highlighting preoperative assessment, intraoperative monitoring, and postoperative care. A multidisciplinary approach is essential, particularly for functional tumors, requiring preoperative screening and pharmacologic preparation. Intraoperatively, cerebral perfusion monitoring is critical to prevent ischemic events. Postoperative vigilance is necessary to detect complications such as bleeding, cranial nerve deficits, and hemodynamic instability. A multidisciplinary team skilled in these surgical procedures is essential to improve safety in carotid paraganglioma surgery.

Gallstone ileus is a rare but serious complication of gallstone disease, often requiring surgical intervention. While enterolithotomy remains the standard treatment, the role of additional biliary surgery, particularly subtotal cholecystectomy, remains controversial. This study examines the management of gallstone ileus in a rural setting, where limited surgical resources and access to specialized biliary interventions pose unique challenges. We present a case series of four patients diagnosed with gallstone ileus in a rural healthcare facility. All patients underwent initial enterolithotomy for bowel obstruction relief. Surgical outcomes, complications, and the necessity for a second intervention, including subtotal cholecystectomy, were evaluated. Ever patient had a successful recovery. Of the four cases, two patients underwent a subtotal cholecystectomy. No perioperative mortality was observed, but limited access to advanced imaging and specialized biliary surgery influenced clinical decision-making. The rural setting in which these series occurred comes with its unique challenges regarding resource management and technological demands.