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经皮胆囊造瘘术治疗患有严重感染性休克和中性粒细胞减少症患者的结石性胆囊炎

Alithiasic cholecystitis treated by percutaneous cholecystostomy in a patient with severe septic shock and neutropenia.

作者信息

Simion N

机构信息

Riviera Hospital, Montreux, Switzerland.

出版信息

J Surg Case Rep. 2012 Feb 1;2012(2):4. doi: 10.1093/jscr/2012.2.4.

Abstract

Acalculous cholecystitis is a relatively rare form of cholecystitis appearing in severely ill patients. We chose the case of a young patient under chemotherapy for myeloid leukaemia who developed a severe septic shock secondary to an alithiasic cholecystitis. Because of hemodynamic instability needing high-dose of vasoactive amines, percutaneous gallbladder drainage was done. After this intervention, the septic shock could be controlled, but a bleeding liver laceration was observed, fortunately without morbidity consequences. Abdominal infections are life-threatening complications in neutropenic patients. Neutropenic enterocolitis is the most important entity, but the acute cholecystitis, even rarer, had been described in several reports, suggesting that this infection could represent a difficult trap.

摘要

无结石性胆囊炎是一种相对罕见的胆囊炎形式,多见于重症患者。我们选择了一例正在接受髓系白血病化疗的年轻患者,该患者因无结石性胆囊炎继发严重感染性休克。由于血流动力学不稳定,需要大剂量血管活性胺类药物治疗,遂进行了经皮胆囊引流术。此次干预后,感染性休克得到控制,但发现肝脏有裂伤出血,所幸未造成不良后果。腹部感染是中性粒细胞减少患者的危及生命的并发症。中性粒细胞减少性小肠结肠炎是最重要的类型,但急性胆囊炎更为罕见,已有多篇报道,提示这种感染可能是一个棘手的问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e485/3649493/4abc5941351d/jscr-2012-2-4fig1.jpg

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