Tapeworm infection and secondary hemorrhagic shock found after cervical cancer surgery: a case report

Radical hysterectomy is an essential component of surgery for early-stage cervical cancer, and secondary hemorrhagic shock due to infection and vaginal stump necrosis after laparoscopic hysterectomy is very rare. Here we report a tapeworm infection and secondary hemorrhagic shock in a patient with cervical cancer after radical hysterectomy. On day two after cervical cancer surgery, this patient was found to have a long-term intestinal tapeworm infection and was discharged on postoperative day 11 after deworming on postoperative day 4. The patient entered the emergency operating room for hemorrhagic shock on day 15 after cervical cancer surgery; after hemodynamic resuscitation, gauze tamponade, and anti-infective treatment, the patient’s massive blood loss temporarily stopped. Two days later, the patient’s vaginal stump bled again repeatedly. Eventually, after 17 hours of surgery and hemodynamic resuscitation, the patient’s wound stopped bleeding profusely with ligation of the right internal iliac artery and branch arteries. This patient had a rare tapeworm infection that presented preoperatively but was detected only after cervical cancer surgery. We considered that preoperative anemia, long surgery time, surgical trauma, and intraoperative blood loss have significantly suppressed the patient’s immune response. A long-term intestinal tapeworm infection increased her susceptibility to bacteria, resulting in secondary pathogenic infection and postoperative blood loss. We advised that if a patient has combined parasitic infection and recurrent fever after a hysterectomy, it is necessary to prolong the hospital stay time, improve anemia, and increase immunity until the condition stabilizes before discharge.

Radical cervical squamous carcinoma; Tapeworm disease; Hemorrhagic shock; Case report

[1] Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020; 8: e191–e203.

[2] Koh W, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2019; 17: 64–84.

[3] Yan X, Li G, Shang H, Wang G, Chen L, Han Y. Complications of laparoscopic radical hysterectomy and pelvic lymphadenectomy-experience of 117 patients. International Journal of Gynecological Cancer. 2009; 19: 963–967.

[4] Le X, Dogan NU, Favero G, Köhler C. Cervical stump necrosis after laparoscopic supracervical hysterectomy: successful management by laparoscopic approach. Journal of International Medical Research. 2021; 49: 3000605211020697.

[5] Paul PG, Prathap T, Kaur H, Shabnam K, Kandhari D, Chopade G. Secondary hemorrhage after total laparoscopic hysterectomy. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2014; 18: e2014.00139.

[6] Raza T, Ullah SR, Mehmood K, Andleeb S. Vancomycin resistant enterococci: a brief review. JPMA. The Journal of the Pakistan Medical Association. 2018; 68: 768–772.

[7] Zhang H, Yang Q, Xiao M, Chen M, Badal RE, Xu Y. Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011. Chinese Medical Journal. 2014; 127: 2429–2433.

[8] Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery. 2017; 152: 784–791.

[9] Göksever Çelik H, Çelik E, Turan G, Seçkin KD, Gedikbaşı A. Risk factors for surgical site infection after hysterectomy. Journal of Infection in Developing Countries. 2017; 11: 355–360.

[10] Malzoni M, Tinelli R, Cosentino F, Perone C, Iuzzolino D, Rasile M, et al. Laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our instruments and technique. Surgical Oncology. 2009; 18: 289–297.

[11] Diamantis T, Kontos M, Arvelakis A, Syroukis S, Koronarchis D, Papalois A, et al. Comparison of monopolar electrocoagulation, bipolar electrocoagulation, ultracision, and ligasure. Surgery Today. 2006; 36: 908–913.

[12] Angele MK, Faist E. Clinical review: immunodepression in the surgical patient and increased susceptibility to infection. Critical Care. 2002; 6: 298–305.

[13] Mbanefo EC, Le L, Pennington LF, Hsieh YJ, Odegaard JI, Lapira K, et al. PSE, a urogenital parasite-derived immunomodulatory molecule, suppresses bladder pathogenesis and anti-microbial peptide gene expression in bacterial urinary tract infection. Parasites & Vectors. 2020; 13: 615.

[14] CystiTeam Group for Epidemiology and Modelling of Taenia solium Taeniasis/Cysticercosis. The World Health Organization 2030 goals for Taenia solium: insights and perspectives from transmission dynamics modelling: CystiTeam Group for Epidemiology and Modelling of Taenia solium Taeniasis/Cysticercosis. Gates Open Research. 2019; 3: 1546.

[15] Gazzinelli-Guimaraes PH, Nutman TB. Helminth parasites and immune regulation. F1000Research. 2018; 7: 1–12.

[16] Mishra PK, Palma M, Bleich D, Loke P, Gause WC. Systemic impact of intestinal helminth infections. Mucosal Immunology. 2014; 7: 753–762.

[17] Mačak Kubašková T, Mudroňová D, Vargová M, Reiterová K, Hrčková G. Cellular and humoral peritoneal immunity to Mesocestoides vogae metacestode infection in mice. Parasites & Vectors. 2021; 14: 54.

[18] Brosschot TP, Lawrence KM, Moeller BE, Kennedy MHE, FitzPatrick RD, Gauthier CM, et al. Impaired host resistance to Salmonella during helminth coinfection is restored by anthelmintic treatment prior to bacterial challenge. PLoS Neglected Tropical Diseases. 2021; 15: e0009052.