Early detection and management of perioperative anaphylactic shock during laparotomy for adenomyosis and oophorectomy: a case report

Abstract

Perioperative anaphylactic shock is a rare but life-threatening medical emergency that requires prompt recognition and immediate intervention. The incidence, though uncommon, carries significant morbidity and mortality if not managed swiftly. Identifying high-risk patients is often challenging, as reactions may occur even without a prior history of allergies.
A 33-years-old female patient diagnosed with adenomyosis and endometriosis with pelvic adhesions, undergoing adenomyosis resection and oophorectomy via laparotomy. The patient had no prior history of drug or food allergies. General anaesthesia was induced using fentanyl, propofol, atracurium, and maintained with sevoflurane. Shortly after administration of prophylactic antibiotics, the patient developed a sudden drop in oxygen saturation, elevated peak inspiratory pressure, severe hypotension, tachycardia, bronchospasm, and angioedema. A clinical diagnosis of anaphylactic shock was made. Immediate resuscitation was initiated with intravenous fluids, subcutaneous epinephrine, intravenous methylprednisolone, and antihistamines. Following treatment, the patient’s hemodynamic status improved and facial oedema gradually resolved. Postoperative management was conducted in the intensive care unit with mechanical ventilation and continuous sedation, followed by successful extubation within 24 hours. The patient was discharged without complications on 3rd postoperative day.
Early recognition and vigilance for perioperative anaphylaxis, even in patients without prior allergic history, are
crucial. Prompt, coordinated multidisciplinary management, supported by thorough preoperative evaluation,
availability of emergency medications, and meticulous perioperative monitoring, is essential to optimize patient
safety and outcomes.

Keywords: Adenomyosis; Anaphylactic Shock; General Anesthesia; Oophorectomy; Perioperative; Allergic Reaction

Citation: Oktavianto G, Lestari AP, Fuadi I. Early detection and management of perioperative anaphylactic shock
during laparotomy for adenomyosis and oophorectomy: a case report. Anaesth. pain intensive care 2025;29(9):1327
32. DOI: 10.35975/apic.v29i9.3075

Received: August 31, 2025; Revised: September 03, 2025; Accepted: September 07, 2025