Medics have issued a warning over a life-threatening condition that killed the wife of former Scotland football captain Colin Hendry
It came after a 45 woman almost died after receiving liposuction at a hospital in the West Midlands.
Fat embolism syndrome occurs when fat molecules travel to and block the small vessels of the lung and other parts of the body, causing damage to the brain and leading to respiratory failure.
It can be difficult to diagnose in the first 24 hours, but then symptoms can come on rapidly.
They include extreme breathlessness, pain in the chest, fever, rash and a high heart rate. Patients may also suffer disorientation, confusion and seizures, and can go into a coma. Some need life support.
Illnesses that can lead to FES include fractures, pancreatitis and severe burns, but it can also be caused - more rarely - by procedures such as hip or knee replacements or liposuction.
Writing in the journal BMJ Case Reports, experts from the intensive care unit at Sandwell and West Birmingham Hospitals NHS Trust said they treated a 45-year-old woman with FES after she underwent liposuction on her legs at another, local hospital.
She was obese but also had lipoedema, in which parts of the body become enlarged due to a build-up of abnormal fat cells.
The surgery had been planned to remove some of the bulk of her lower legs to help her become more mobile and go on to lose weight. Around 10 to 13.5 litres of fluid and fat was removed during the surgery, which had gone to plan.
However, the woman became severely ill around 36 hours later. She became drowsy, had breathing trouble, rapid heart rate, rash and was urinating less.
She was transferred to intensive care with very low oxygen levels, indicating acute respiratory distress syndrome. She was ventilated and given respiratory support, as well as other medications. The woman stayed in hospital for two weeks before being well enough to go home.
The authors concluded that doctors should be on their guard for signs of FES, especially in patients with other issues such as obesity or fluid retention.
They said: "Liposuction is a procedure that is growing more common worldwide and is being done in higher-risk patient groups with more comorbidities.
"While generally a safe procedure, it is important to consider the potential of fat embolism syndrome (FES) as a diagnosis in the post-procedure period."
Complications from liposuction hit the headlines in 2009 when Denise Hendry died in 2009 after bacteria spread from her stomach to her brain causing meningitis.
Mrs Hendry, 43, spent seven years fighting illness after a botched liposuction operation in April 2002.
She suffered nine punctures to her bowel during the procedure.
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