泌尿道感染敗血症引發手指壞疽:病例報告與文獻回顧
郭名翔1沈坤宏1
奇美醫學中心 外科部 泌尿外科12
Urosepsis leading to finger gangrene : Cases report and literature review
Ming-Hsiang Kuo1、 Kun-Hung Shen 1Department of Surgery, Division of Urology1, Chi Mei Medical Center, Tainan, Taiwan
Introduction:
Post-sepsis syndrome is a condition that affects up to 50% of sepsis survivors. They are left with physical and/or psychological long-term effects. For some patients, the cause of their PSS is obvious. Blood clots and poor blood circulation while they were ill may have caused gangrene and the need for amputations of fingers, toes, or limbs.
We would like to introduce a rare case of Urosepsis leading to finger gangrene in our hospital
Case report:
This is a 61 y/o female with history of DM and HTN.This time, the patient suffered from right flank pain for 2 days. The patient visited our GU OPD and right ureteral stone was suspected. The patient was transfered to our ER for further evaluation. At ER, malaise and low BP was found. Lab data showed pandemia and abdominal CT showed right lower third ureteral stone with hydronephrosis. Under the impression of urosepsis, the patient was admitted to SICU for further care.
Right PCN was done for decompression and infection control. However, agressive hemodynamic support with fluid replacement and high dosage of Levophed+Dopamin was need for keep vital stable. General condition stabilized gradually. However,right finger (第1-4指)gangrene change was noted, and we consult P.S Dr. Bokey, Pletaal, PGE1 and 紅外線照射 was suggested. Further amputation will be needed after gangrene margin became clear. However, sever leukocytosis (WBC >40000) was noted for days. Thus, we kept infection control first. Clinical condition got stable gradually. Operation with amputation was done after general condition got more stable.
Conclusion
Post-sepsis syndrome is a condition that affects up to 50% of sepsis survivors. They are left with physical and/or psychological long-term effects. The risk of having PSS is higher among people who were admitted to an intensive care unit (ICU) and for those who have been in the hospital for extended periods of time
We would like to share our cases and compare with literatures published to give a whole picture of the disease in diagnosis, treatment and Prognosis.