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Received Nov 6, 2017; Accepted Feb 28, 2018
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1. Introduction
The viral or bacterial infection of the parotid gland is called parotitis and is one of the several types of sialadenitis [1]. Postoperative parotitis has been described as a complication of abdominal surgery [2]. The reported incidence in a large retrospective study was as low as 0.0028% [3]. Except from abdominal, acute parotitis has also been described in other types of operations such as those of neurosurgery field [4]. However, it has never been described as a postamputation complication in literature. In the present article, we report a postamputation case of parotitis and its management. We also investigate all possible risk factors for such a complication and we discuss the pathophysiology.
2. Case Report
An 83-year-old man with a history of peripheral artery disease and diabetes mellitus (DM) was admitted to hospital with gangrene below the level of ankle of the right foot. The patient was septic, with fever 37.6°C, WBC: 29.6 × 109/L, Hct: 39.2%, CRP: 161 mg/L, and Cr: 5.2 μmol/L. Diabetes mellitus had already resulted in complications such as diabetic retinopathy and nephropathy. Due to the severity of his condition, the patient emergently underwent amputation above the knee under general anesthesia. During the operation, the patient was transfused with one unit of concentrated red blood cells. The procedure was uneventful, and the patient woke up normally.
In the first four postoperative days, patient’s wound was in good condition, and his renal function and inflammation markers were also improving. He also had no fever. However, he was considered to be severely malnourished because his albumin levels were 1.2 g/dL and had anasarca. The patient was started on a high-protein diet and intravenous antibiotics and was transfused with one unit of concentrated red blood cells during this time.
On the fifth postoperative day, the patient had right parotid gland swelling and fever...