Fulminant Food Aspiration-Induced Pneumonia Leading to Tension Pyopneumothorax after Proctectomy: An Autopsy Case

INTRODUCTION: Postoperative aspiration pneumonia is an uncommon but severe pulmonary complication, particularly in older adults with cognitive impairment. We report an autopsy case of fulminant aspiration pneumonia, caused by food aspiration following colorectal cancer surgery, that progressed to tension pyopneumothorax. CASE PRESENTATION: species were also present, confirming aspiration pneumonia complicated by lung abscesses. Multiple pleural surface perforations from these abscesses likely caused substantial air leakage into the pleural space, culminating in uncontrolled tension pyopneumothorax. No histological signs of chronic aspiration were found. CONCLUSIONS: In older adults with dementia, massive food aspiration can lead to fatal pneumonia with progression to pyopneumothorax, even in the absence of prior aspiration history. Vigilance is essential when resuming oral intake in such patients after surgery.