Asian Journal of Case Reports in Surgery

Background: Overwhelming post-splenectomy infection (OPSI) is a rare but life-threatening complication that can progress rapidly to septic shock and multiorgan failure. The spleen, the largest lymphatic organ, performs key immunological and haematological functions and supports innate and adaptive immunity. Because of its rapid progression and high mortality, OPSI requires early identification, immediate management and vigilant post-splenectomy care.

Case Presentation: We report the case of a 56-year-old man with diabetes mellitus and hepatitis B who sustained multiple traumatic injuries following a fall from height. Computed tomography revealed a Grade IV splenic laceration requiring emergency splenectomy. He underwent operative management and received postoperative pneumococcal vaccination. Initial recovery was uneventful, and he was extubated on postoperative day 3. On postoperative day 6, he developed fever, restlessness and altered sensorium, followed by recurrent hypoglycaemic episodes. Blood cultures grew Serratia marcescens, a Gram-negative facultative anaerobic opportunistic bacterium. Despite mechanical ventilation, vasopressor support and antibiotic escalation, he deteriorated into septic shock with multiorgan dysfunction syndrome and died on postoperative day 9.

Conclusion: This case highlights the possibility of rapidly fatal infection after splenectomy, including infection caused by atypical Gram-negative organisms. It emphasises the need for early sepsis recognition, strict preventive protocols, timely empirical antimicrobial therapy, documented asplenic status, patient education and long-term multidisciplinary follow-up in splenectomised patients.