致死性的尿路敗血症–一個在更換結殼的雙J導管時不常見的併發症
楊鎧伍、周詠欽
嘉義基督教醫院 外科部 泌尿科
Lethal urosepsis – an uncommon complication in treating patient with encrusted ureteral double J stent
Kai-Wu Yang, Yeong-Chin Jou
Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital
Introduction:
The use of ureteral stent has become a basic part of many urological procedures and the incidence of encrustation is not rare. Management of encrustated double J catheter varies depends on degree of encrustation and clinical conditions. In this report, we present an uncommon complication, lethal urosepsis, in treating patient with encrusted ureteral double J stent.
Case presentation:
This 88-year-old female was a bedridden victim who suffered from left side urinary stone and obstructive uropathy with episode of urosepsis. Because her family hesitated about further surgical treatment of her stone disease after infection control, left side double J stenting was applied then. The double J catheter had been changed regularly every two months since then due to frequent stone formation on the catheter. However, during the last time of double J stent revision, the double J stent was unable to be removed because of severe encrustation. Cystolithotripsy and ureterolithotripsy were performed then for encrustation over the entire double J catheter and the double J stent was removed successfully. Unfortunately, postoperative severe urosepsis with septic shock was followed, which leading to be multiple organ failure, despite of immediate admission for empire antibiotic treatment. The patient was expired on postoperative day three due to uncontrolled urosepsis.
Conclusions:
This case report reminds us about that changing encrusted double J stent can lead to be a fatal postoperative urosepsis without adequate preoperative treatment and survey. At once encrusted double J stent is identified, adequate antibiotics treatment for urinary tract infection preoperatively or percutaneous nephrostomy drainage is crucial in order to avoid lethal complication in the future.