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Acute primary abdominal compartment syndrome due to Clostridium difficile induced toxic megacolon
- Source :
- Anaesthesiology Intensive Therapy, Vol 51, Iss 4, Pp 273-282 (2019)
- Publication Year :
- 2019
- Publisher :
- Via Medica, 2019.
-
Abstract
- Background Without timely diagnosis, acute primary abdominal compartment syndrome (ACS) is a potentially fatal syndrome and often goes unrecognized until severe symptoms appear. Early diagnosis may significantly improve the prognosis of these patients. Case presentation We present the case of a 54-year-old man, successfully treated for acute myeloid leukemia with cytosine arabinoside, admitted to the intensive care unit with severe shock, refractory to standard therapy with antibiotics, fluid resuscitation, and vasopressors. Early diagnosis of acute primary abdominal syndrome was made based on an intra-abdominal pressure of 20 mm Hg (3 kPa) with new onset organ failure, after which decompressive laparotomy was performed. Stool cultures grew Clostridium difficile. Despite abdominal decompression, the abdominal compartment syndrome persisted with the development of toxic megacolon and a total colectomy was performed with favorable evolution. Methods A systematic review of published case reports was performed describing a primary ACS due to C. difficile toxic megacolon. A PubMed database search was performed with the following search terms, single or in combination: 'clostridium difficile', 'toxic megacolon', 'abdominal compartment syndrome', and 'CDI'. The latest search was performed for March 2019; only case reports after 1998 were included. Results We found a total of 19 case reports with C. difficile toxic megacolon (including the present case). The male/female ratio was 12/7, and there were 3 children. The mean age was 48.7 ± 23.5 years. The reason for admission was sepsis in 6, trauma in 2, postoperative in 4, enterocolitis in 5, pregnancy in 1 and abdominal complaints after topical antibiotics in 1. Three patients did not develop diarrhea. Five patients presented with diarrhea on average 5.8 ± 5.1 (median 4, 1-14) days prior to hospital admission while 7 patients developed diarrhea on average after 10 ± 19.6 (median 3, 0-54) days during admission. The intra-abdominal pressure (measured in 6 patients, including ours) was 29.2 ± 11 (20-50) mm Hg (3-7 kPa). Treatment consisted of (a combination of) vancomycin (orally or via rectal enemas), metronidazole (orally or intravenously), and surgical intervention (with decompressive laparotomy). Three patients died (15.8%). Conclusions Monitoring of intra-abdominal pressure allows early detection of abdominal compartment syndrome and is warranted in patients with C. difficile infection and/or toxic megacolon. Early decompression can lead to improved outcomes in patients with severe shock and organ failure.
- Subjects :
- Adult
Male
Toxic megacolon
medicine.medical_specialty
Abdominal compartment syndrome
colitis
Critical Care and Intensive Care Medicine
law.invention
Megacolon, Toxic
Sepsis
abdominal hypertension
sepsis
Abdominal decompression
law
Anesthesiology
medicine
Humans
RD78.3-87.3
Colectomy
Aged
Enterocolitis
Laparotomy
Clostridioides difficile
business.industry
Septic shock
RC86-88.9
Medical emergencies. Critical care. Intensive care. First aid
General Medicine
Middle Aged
Clostridium difficile
clostridium difficile
Decompression, Surgical
medicine.disease
Intensive care unit
toxic megacolon
Anti-Bacterial Agents
Surgery
abdominal compartment syndrome
Anesthesiology and Pain Medicine
Clostridium Infections
septic shock
Female
abdominal pressure
Intra-Abdominal Hypertension
medicine.symptom
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Anaesthesiology Intensive Therapy, Vol 51, Iss 4, Pp 273-282 (2019)
- Accession number :
- edsair.doi.dedup.....6152ef8b8394c9fe0e84912b5efa25f7