[A case of sepsis complicated by multiple organ dysfunction syndrome with CT appearance of pseudo-subarachnoid hem-orrhage].

Q2 Medicine
Yan Qi
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引用次数: 0

Abstract

A 39-year-old male patient was admitted to hospital with abdominal distension, unconsciousness, and anuria. Head computed tomography (CT) showed subarachnoid hemorrhage and diffuse cerebral edema. The high-density area of contrast accumulation region in the high-density CT plaque was 38 HU, and the preliminary diagnosis was SAH, incomplete intestinal obstruction, and sepsis caused by acute cerebrovascular disease. After admission, the patient displayed upturned eyes, limb convulsions, serum procalcitonin level exceeding 100 ng/mL, low blood pressure and septic shock. Imipenem was given for intensive anti-infection therapy. After treatment, procalcitonin levels showed a slow decline, renal function, and intra-abdominal pressure returned to normal, urine volume gradually increased, but platelets still showed a downward trend. Lumbar puncture showed colorless and clear cerebrospinal fluid, and the biochemical and routine results of cerebrospinal fluid were normal. SAH and intracranial infection were excluded, and it was considered that the head CT showed pseudo-subarachnoid hemorrhage. On the 3rd day of admission, laparoscopic exploratory laparotomy+appendectomy+abdominal drainage under general anesthesia were performed. During surgery, purulent gangrene in the appendix was found, with pus adhering to the surface of the intestines and a large amount of pus present in the abdominal cavity. Rhabdomyolysis syndrome developed after surgery. After continuous renal replacement therapy, the indicators gradually returned to normal. The patient was conscious, and the head CT results were normal. The patient was discharged from the hospital on the 19th day after surgery, and no special discomfort and abdominal pain and distension occurred during the 3-month follow-up.

脓毒症合并多脏器功能障碍伴蛛网膜下腔出血的CT表现1例。
39岁男性患者因腹胀、意识不清、无尿而入院。头部电脑断层扫描显示蛛网膜下腔出血及弥漫性脑水肿。高密度CT斑块造影剂堆积区高密度面积为38 HU,初步诊断为SAH、不完全性肠梗阻、急性脑血管病脓毒症。患者入院后出现突然上仰眼、四肢抽搐、血清降钙素原水平超过100ng/mL、低血压、感染性休克。给予亚胺培南强化抗感染治疗。治疗后降钙素原水平缓慢下降,肾功能恢复正常,腹内压降至正常,尿量逐渐增加,但血小板仍呈下降趋势。腰椎穿刺显示脑脊液无色透明,脑脊液生化及常规检查正常。排除SAH及颅内感染,认为头部CT扫描表现为假性蛛网膜下腔出血。入院第4天全麻下行腹腔镜探查开腹+阑尾切除术+腹腔引流术。术中阑尾可见化脓性坏疽,肠表面可见脓肿及苔藓,腹腔内可见大量脓。术后出现横纹肌溶解综合征。经持续肾替代治疗后,各项指标逐渐恢复正常。患者神志清醒,头部CT检查正常。患者于术后第10天出院,随访3个月未出现特别不适及腹痛、腹胀。
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来源期刊
CiteScore
3.80
自引率
0.00%
发文量
67
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