Acute Intraoperative Disseminated Intravascular Coagulation During Suppurative Keloid Excision: A Case Report

Objective:Unusual clinical course Background:Disseminated intravascular coagulation (DIC) is a severe coagulopathy characterized by widespread microvascular thrombosis and consumptive coagulopathy, leading to both thrombosis and hemorrhage.Whereas DIC is well documented in sepsis, trauma, and malignancy, its occurrence during surgery -particularly in the context of chronic inflammation and localized infected wounds -is exceedingly rare. Case Report:Acute intraoperative DIC occurred in a 62-year-old woman during suppurative keloid excision.The patient had a history of recurrent keloids with chronic inflammation but no prior coagulopathy, and preoperative coagulation test results were normal.During the procedure, she developed excessive bleeding; postoperative laboratory results showed prolonged prothrombin time, low fibrinogen and platelet levels, and substantially elevated D-dimer, confirming DIC based on the International Society on Thrombosis and Haemostasis criteria.The patient received multimodal treatment, including aggressive blood product transfusion (fresh frozen plasma, cryoprecipitate, and platelet concentrate), broad-spectrum antibiotics (meropenem and daptomycin) targeting a presumed deep-seated infection, and continuous renal replacement therapy for acute kidney injury.Coagulation parameters improved within 14 hours; the patient achieved full recovery from the DIC episode and its acute complications. Conclusions:This case highlights the potential for acute intraoperative DIC in patients with chronic inflammatory conditions and underscores the importance of early recognition, intraoperative coagulation monitoring, and a multidisciplinary management approach.Timely adherence to international DIC management guidelines may substantially improve patient outcomes in such rare but life-threatening scenarios.