Gut-Origin Sepsis After Radical Cystectomy and Ileal Conduit: Early Intensive Care Unit Recognition and Targeted Management Leading to Rapid Recovery

Abstract

Introduction: Gut-origin sepsis is an important but under-recognized source of postoperative systemic inflammation in critically ill patients. Disruption of the intestinal mucosal barrier after major surgery may facilitate bacterial translocation and trigger systemic inflammatory responses, even without overt intra-abdominal infection or positive blood culture. Early recognition remains challenging because clinical manifestations are often nonspecific, underscoring the value of simple, available biomarkers.

Case Description: We report a 74-year-old man who developed early features suggestive of gut-origin sepsis after open radical cystectomy with ileal conduit for muscle-invasive bladder cancer. Despite stable macrocirculatory parameters and no vasopressor requirement, the patient exhibited persistent hyperlactatemia (6.1 mmol/L), lymphopenia (absolute lymphocyte count 711/µL), and an elevated neutrophil-to-lymphocyte ratio (NLR 16.9). Prompt admission to the intensive care unit and early targeted management—including optimized fluid resuscitation with albumin, broad-spectrum antimicrobial therapy, empirical antifungal coverage, and multimodal opioid-sparing analgesia—were followed by rapid clinical and laboratory improvement. Within 72 hours, serum lactate decreased to 2.8 mmol/L, the absolute lymphocyte count rose to 792/µL, and the NLR fell to 13.1. The patient was successfully extubated and discharged from the intensive care unit without progression to multiple organ dysfunction.

Conclusion: This case underscores the clinical value of early intensive care recognition of gut-origin sepsis using simple, routinely available biomarkers, such as serum lactate, absolute lymphocyte count, and NLR. Optimal outcomes depend on a high index of suspicion and timely, physiology-based intervention delivered through a coordinated critical care approach in high-risk postoperative patients.

Keywords: Gut-Origin Sepsis, Intensive Care Unit, Lactate, Neutrophil-To-Lymphocyte Ratio, Postoperative Sepsis