DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.040

Pages: 2594-2596

Acute postoperative adrenal vascular abnormalities are uncommon and may present with nonspecific pain. A 73-year-old woman underwent anterior resection for rectal adenocarcinoma (pT3N0Mx). On postoperative day seven, she developed isolated acute left lumbar pain. Contrast-enhanced computed tomography (CT) demonstrated diffuse enlargement of the left adrenal gland and increased caliber of the left adrenal vein, without a definite intraluminal filling defect; the left renal vein remained patent. Morning cortisol was 320 nmol/L and adrenocorticotropic hormone was 25 pg/mL, without a reported clinical adrenal crisis. Enoxaparin was administered at 60 mg subcutaneously twice daily for one month, followed by 40 mg twice daily for another two months. The pain resolved, and CT at one and three months showed sustained regression of adrenal enlargement. A vascular or congestive mechanism was suspected, but adrenal vein thrombosis was not demonstrated. This case highlights the importance of cautious imaging interpretation and serial follow-up in postoperative unilateral adrenal abnormalities.