This case report describes an exceptionally rare occurrence of severe acute respiratory distress syndrome following laparoscopic appendectomy in a previously healthy 57-year-old male. The patient presented with acute appendicitis and underwent an uncomplicated surgical procedure. Approximately 4 h postoperatively, he developed rapid respiratory deterioration with severe hypoxemia, fulfilling the Berlin criteria for severe acute respiratory distress syndrome (partial pressure of arterial oxygen/fraction of inspired oxygen ratio, 99.2). Other causes, including aspiration, pulmonary embolism, and cardiac failure, were excluded. The patient was managed in the intensive care unit with lung-protective ventilation in accordance with the Acute Respiratory Distress Syndrome Network (ARDSNet) protocol along with antibiotics and corticosteroids. He demonstrated rapid clinical improvement, was extubated on postoperative day 7, and discharged on postoperative day 8. This case highlights that severe acute respiratory distress syndrome, although rare, can complicate routine surgical procedures and underscores the importance of early recognition and multidisciplinary management in achieving favorable outcomes.
Zhang et al. (2026) studied this question.