S5191 Fungal Intestinal Perforation Requiring Hemicolectomy in an Immunocompromised Patient With Stage IV Lung Adenocarcinoma

Introduction: Intestinal perforation in immunocompromised patients presents unique diagnostic and therapeutic challenges. Fungal invasion of the gastrointestinal mucosa can lead to tissue necrosis and life-threatening perforations, particularly in patients with prolonged hospitalization and multiple risk factors for opportunistic infections. Case Description/Methods: A 68-year-old man with stage IV lung adenocarcinoma underwent prolonged ICU care requiring mechanical ventilation and central venous access. After initial successful treatment of Candida albicans candidemia with micafungin, the patient developed acute abdominal distention and respiratory distress 24 days later. Computed tomography (CT) imaging revealed large-volume pneumoperitoneum consistent with perforated viscus. Emergency exploratory laparotomy identified 2 perforations in the proximal right colon requiring right hemicolectomy. Intraoperative findings included friable, necrotic bowel wall with purulent peritoneal contamination. Peritoneal fluid cultures grew Candida glabrata and vancomycin-resistant Enterococcus faecium, confirming polymicrobial fungal-bacterial peritonitis. Despite aggressive surgical source control and appropriate antimicrobial therapy, the patient developed post-operative multisystem organ failure and expired 3 days after surgery. Discussion: This case illustrates the challenging intersection of fungal pathogenesis and gastrointestinal complications in critically ill patients. Fungal invasion likely contributed to bowel wall necrosis through direct tissue invasion, compounded by immunosuppression and compromised mesenteric perfusion. The polymicrobial nature of the peritoneal infection reflects translocation across a compromised mucosal barrier. Surgical decision-making in this high-risk patient required balancing aggressive source control against operative mortality risk.