Sepsis Management in Post Exploratory Laparotomy due to Total Bowel Obstruction and Gaster Perforation: A Case Report
Keywords:
sepsis, laparotomy, intensive care unitAbstract
Background: Sepsis remains a leading cause of mortality worldwide despite the advancement of intensive care, particularly in low- and middle-income countries (LMICs) where resources are limited. Early recognition as well as timely and intensive management is necessary to lower the mortality. This case report aimed to highlight the critical role of early sepsis detection and timely management in successful outcomes, even in resource-constrained environments.
Case Report: We reported a case of 64-year-old woman presented with chief complaints of not being able to defecate and has not passed gas for 5 days, accompanied with stomach ache, bloating, and mucus in the stool. The patient was diagnosed with total bowel obstruction due to suspect intussusception, sepsis, hyponatremia hypovolemic and acute kidney injury. An exploration laparotomy with right hemicolectomy and end-to-end anastomose procedures were then performed. Blood culture showed Escherichia coli and Extended Spectrum b-Lactamase (ESBL) while urine culture showed Candida tropicalis. Intensive management comprised of resuscitation, antibiotics and antifungal treatment lead to improvement within eight days of admission. The patient was discharged fourteen days after surgery.
Conclusion: The successful outcome of this case highlights the importance of early recognition and aggressive management of sepsis, especially in resource-limited environments.
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Srzić I, Adam VN, Pejak DT. Sepsis definition: What’s new in the treatment guidelines. Acta clinica croatica. 2022; 61:67.
Markwart R, Saito H, Harder T, Tomczyk S, Cassini A, Fleischmann-Struzek C, et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive care medicine. 2020; 46:1536-51.
Xie J, Wang H, Kang Y, Zhou L, Liu Z, Qin B, et al. The epidemiology of sepsis in Chinese ICUs: a national cross-sectional survey. Critical care medicine. 2020; 48:e209-e18.
Sakr Y, Jaschinski U, Wittebole X, Szakmany T, Lipman J, Ñamendys-Silva SA, et al. Sepsis in intensive care unit patients: worldwide data from the intensive care over nations audit. Open forum infectious diseases; 2018: Oxford University Press US.
Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd K, Schlattmann P, et al. Incidence and mortality of hospital-and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive care medicine. 2020; 46:1552-62.
Stephen AH, Montoya RL, Aluisio AR. Sepsis and septic shock in low-and middle-income countries. Surgical infections. 2020; 21:571-8.
Do SN, Luong CQ, Pham DT, Nguyen MH, Nguyen NT, Huynh DQ, et al. Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study. Scientific reports. 2021; 11:18924.
Pramono A, Rahmat B, Husain ASF, Pambudi AR. Identification of mortality risk factors in the intensive care unit (ICU). AIP Conference Proceedings; 2024: AIP Publishing.
Arvaniti K, Dimopoulos G, Antonelli M, Blot K, Creagh-Brown B, Deschepper M, et al. Epidemiology and age-related mortality in critically ill patients with intra-abdominal infection or sepsis: an international cohort study. International Journal of Antimicrobial Agents. 2022; 60:106591.
Xiong Y-m, Rao X. Clinical and microbiological characteristics of patients with complicated intra-abdominal infections in intensive care unit. Current Medical Science. 2020; 40:104-9.
Liu Y-C, Yao Y, Yu M-M, Gao Y-L, Qi A-L, Jiang T-Y, et al. Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis. BMC infectious diseases. 2022; 22:564.
Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019—results from a systematic review and meta-analysis. Critical Care. 2020; 24:1-9.
Dupuis C, Bouadma L, Ruckly S, Perozziello A, Van-Gysel D, Mageau A, et al. Sepsis and septic shock in France: incidences, outcomes and costs of care. Annals of intensive care. 2020; 10:1-9.
Fekadu G, Tolera A, Beyene Bayissa B, Merga BT, Edessa D, Lamessa A. Epidemiology and causes of intestinal obstruction in Ethiopia: a systematic review. SAGE Open Medicine. 2022; 10:20503121221083207.
Panzera F, Di Venere B, Rizzi M, Biscaglia A, Praticò CA, Nasti G, et al. Bowel intussusception in adult: prevalence, diagnostic tools and therapy. World Journal of Methodology. 2021; 11:81.
Gauer R, Forbes D, Boyer N. Sepsis: diagnosis and management. American family physician. 2020; 101:409-18.
Niederman MS, Baron RM, Bouadma L, Calandra T, Daneman N, DeWaele J, et al. Initial antimicrobial management of sepsis. Critical care. 2021; 25:1-11.
Jia L, Wang P, Li C, Xie J. The efficacy and safety of vasopressors for septic shock patients: A systemic review and network meta-analysis. Shock. 2023; 60:746-52.
Reddy S, Hu B, Kashani K. Relationship between the rate of fluid resuscitation and acute kidney injury: A retrospective cohort study. International Journal of Critical Illness and Injury Science. 2023; 13:104-10.
Dong W-H, Yan W-Q, Song X, Zhou W-Q, Chen Z. Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: a systematic review and meta-analysis. Scandinavian journal of trauma, resuscitation and emergency medicine. 2022; 30:28.
Manrique-Caballero CL, Del Rio-Pertuz G, Gomez H. Sepsis-associated acute kidney injury. Critical Care Clinics. 2021; 37:279-301.
Flannery AH, Li X, Delozier NL, Toto RD, Moe OW, Yee J, et al. Sepsis-associated acute kidney disease and long-term kidney outcomes. Kidney medicine. 2021; 3:507-14. e1.
Chang Y-M, Chou Y-T, Kan W-C, Shiao C-C. Sepsis and acute kidney injury: a review focusing on the bidirectional interplay. International Journal of Molecular Sciences. 2022; 23:9159.
Zou Z-y, Sun K-j, Fu G, Huang J-j, Yang Z-j, Zhou Z-p, et al. Impact of early empirical antifungal therapy on prognosis of sepsis patients with positive yeast culture: A retrospective study from the MIMIC-IV database. Frontiers in Microbiology. 2022; 13:1047889.
Nathan N, Sculier J-P, Ameye L, Paesmans M, Bogdan-Dragos G, Meert A-P. Sepsis and septic shock definitions in patients with cancer admitted in ICU. Journal of Intensive Care Medicine. 2021; 36:255-61.
Mauri T, Spinelli E, Pavlovsky B, Grieco DL, Ottaviani I, Basile MC, et al. Respiratory drive in patients with sepsis and septic shock: modulation by high-flow nasal cannula. Anesthesiology. 2021; 135:1066-75.
Gourd NM, Nikitas N. Multiple organ dysfunction syndrome. Journal of intensive care medicine. 2020; 35:1564-75.
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