Jagbir Grewal¹, Victoria Kueppers¹

¹Department Of Forensic Pathology, PathWest Laboratory Medicine WA

Fat embolism syndrome (FES) is a rare but potentially fatal condition that most commonly arises following orthopaedic trauma, though it can also occur after surgical manipulation of adipose tissue. This report details the case of a 63-year-old female patient with multiple significant comorbidities, including ischaemic heart disease, type 2 diabetes mellitus, hypertension, marked obesity, obstructive sleep apnoea, asthma, and a substantial history of smoking.

The patient underwent elective abdominal incisional hernia repair but failed to return to her baseline functional status postoperatively. Instead, her condition progressively deteriorated despite intensive care unit (ICU) management. Multiple investigations were undertaken across different medical specialties while considering various diagnoses, none of which could be confirmed. Ultimately, her clinical course culminated in multi-organ failure, necessitating palliative care.

During the post-mortem examination, distinctive fatty aggregates were apparent within large vascular spaces of multiple organs, including the liver which appeared necrotic. The presence of fat was confirmed on histological assessment, including Oil Red-O special staining. This case highlights FES as a potentially fatal complication of surgery, to be considered in obese patients where fat displacement may have occurred during surgery.