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Background
Liposuction is a procedure commonly performed in the UK usually with a low incidence of serious sequelae; however with larger patients and increased volumes of lipoaspirate, complications have been reported more frequently. 1-3 Previous reported cases of fat embolism syndrome (FES) following liposuction are rare, but have each described it in the context of liposuction of the abdominal and trochanteric regions with or without abdominoplasty. 4 5 To the authors' knowledge no case report of FES postliposuction have been reported in the UK.
Fat embolisation describes the pathophysiological phenomenon of fat globules being present within peripheral microcirculation or lung tissue, 6 common after long bone fractures or major trauma. In a small number of cases however patients go on to develop the uncommon and potentially fatal FES. It is notoriously difficult to diagnose and features include the triad of respiratory failure, cerebral dysfunction and petechial rash. 7 Usually presenting 24-72hours after the initial injury, 7 the underlying mechanisms are still not clear. However current evidence suggests trauma leading to fat globules or free fatty acids causing microvascular occlusion and consequent end organ dysfunction.
Case presentation
We present the case of a 45-year-old woman had a background history of morbid obesity (body mass index (BMI) 65kg/m2), bilateral leg lipoedema, previous gastric bypass, laparoscopic cholecystectomy, tonsillectomy and depression. The patient was not on any medication which was related to this acute admission.
She had undergone complex bilateral lower leg and knee liposuction 48hours prior at a local hospital. The surgery had been planned to remove some of the bulk of her lower legs to help her mobilise and subsequently begin the weight loss process. She underwent liposuction via the tumescent technique and approximately 10-13.5L of lipoaspirate was removed. The intraoperative period was uneventful, she was extubated an hour after the end of the procedure and transferred to the high dependency unit as planned.
Approximately 36-39hours after the operation the patient became drowsy with a respiratory acidosis and tachycardia as well as a falling urine output. Initial treatment consisted of fluid resuscitation and as she continued to deteriorate she was transferred to intensive care (ITU) with suspected acute respiratory distress syndrome (ARDS).
On arrival initial observations showed a heart rate of 110, blood pressure of...