Man Yifan, Li Shikuan, Yu Zongping
Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, PR China.
Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, PR China.
Int J Surg Case Rep. 2020;76:186-189. doi: 10.1016/j.ijscr.2020.09.159. Epub 2020 Sep 28.
Acute appendicitis is the most common surgical emergency and may present with a wide variety of clinical manifestations. In rare circumstances, appendicitis can cause life-threatening complications e.g. septic shock. We present a case of septic shock caused by acute appendicitis complicated with abscess formation within the mesoappendix.
A 42-year-old male was presented with migratory right lower abdominal pain, accompanied by septic shock and acute kidney failure. We performed emergency appendectomy and unexpectedly observed an abscess within the mesoappendix during surgery. The patient received antibiotic therapy perioperatively. Escherichia coli and Klebsiella pneumoniae subspecies were isolated from the intraoperative pus specimen, and Bifidobacterium was isolated from his preoperative blood culture. Histopathology revealed acute suppurative appendicitis. The patient recovered uneventful and was discharged 5 days after surgery.
We believe that the septic shock was associated with the small abscess formation in the mesoappendix. Bacteria within the mesoappendix could enter the bloodstream through the mesoappendiceal vessel and then septic shock and kidney failure occurred sequentially. We assume that the abscess within the mesoappendix was caused by a tiny perforation from the mesoappendiceal side.
The case of acute appendicitis complicated with abscess formation within mesoappendix explains one of the causes which may lead to septic shock.
急性阑尾炎是最常见的外科急症，可能表现出各种各样的临床表现。在极少数情况下，阑尾炎可导致危及生命的并发症，如感染性休克。我们报告一例由急性阑尾炎并发阑尾系膜脓肿形成导致感染性休克的病例。
一名42岁男性出现转移性右下腹痛，伴有感染性休克和急性肾衰竭。我们进行了急诊阑尾切除术，术中意外发现阑尾系膜内有一个脓肿。患者在围手术期接受了抗生素治疗。从术中脓液标本中分离出大肠杆菌和肺炎克雷伯菌亚种，从其术前血培养中分离出双歧杆菌。组织病理学显示为急性化脓性阑尾炎。患者恢复顺利，术后5天出院。
我们认为感染性休克与阑尾系膜内小脓肿的形成有关。阑尾系膜内的细菌可通过阑尾系膜血管进入血液循环，继而依次发生感染性休克和肾衰竭。我们推测阑尾系膜内的脓肿是由阑尾系膜侧的微小穿孔引起的。
急性阑尾炎并发阑尾系膜脓肿形成的病例解释了可能导致感染性休克的原因之一。
