TRENDELENBURG POSITION–ASSOCIATED INTRA-OPERATIVE HYPOTENSION IN A PATIENT WITH DESCENDING COLON CARCINOMA AND ACUTE INTESTINAL OBSTRUCTION: A CASE REPORT

Abstract

Background and Aims: Intraoperative hypotension (IOH), particularly when mean arterial pressure falls below 65 mmHg, has been linked to adverse perioperative outcomes. Although the Trendelenburg position is frequently employed to augment venous return and improve surgical exposure, it may produce unexpected cardiovascular compromise in selected clinical settings. We describe a case of severe positional hypotension during emergency laparotomy for large bowel obstruction.

Case Description: A 58-year-old woman without known comorbidities underwent emergency exploratory laparotomy for descending colon carcinoma causing acute intestinal obstruction. Shortly after induction of general anesthesia and placement in moderate Trendelenburg position, she developed marked hypotension (70/40 mmHg) that was poorly responsive to fluid resuscitation and vasopressors. Hemodynamic stability was rapidly restored after returning the patient to the neutral supine position.

Conclusion: In patients with raised intra-abdominal pressure secondary to bowel obstruction, Trendelenburg positioning may impair venous return rather than enhance it. Awareness of this phenomenon and prompt positional correction are essential to prevent sustained hypotension and end-organ compromise.