RESUMO
Liver abscess remains a life-threatening disease, particularly when it results in systemic organ failure necessitating intensive care. Only few cases of respiratory failure caused by liver abscess and treated with veno-venous extracorporeal membrane oxygenation (ECMO) have been reported. Here we present a case of liver abscess with rapid progression of multiple organ dysfunction, including severe acute respiratory failure on admission to the intensive care unit (ICU). Upon admission, we immediately initiated artificial organ support systems, including ventilator, continuous renal replacement therapy, and cardiovascular drug infusion for septic multiple organ failure and source control. Despite this initial management, respiratory failure deteriorated and V-V ECMO was introduced. The case developed abdominal compartment syndrome, for which we performed a bedside decompressive laparotomy in the ICU. The case gradually recovered from multiple organ failure and was discharged from the ICU on day 22 and from the hospital on day 53. Since liver abscess is potentially lethal and respiratory failure on admission is an additional risk factor of mortality, V-V ECMO may serve as an adjunctive choice of artificial organ support for cases of severe acute respiratory failure caused by liver abscess.
Assuntos
Cuidados Críticos , Oxigenação por Membrana Extracorpórea/métodos , Abscesso Hepático/complicações , Síndrome do Desconforto Respiratório/terapia , Idoso de 80 Anos ou mais , Humanos , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologiaAssuntos
Carcinoma de Células Escamosas/cirurgia , Doenças do Esôfago/etiologia , Esôfago/patologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Doença Aguda , Idoso , Alginatos/administração & dosagem , Anemia/etiologia , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Cateterismo , Doenças do Esôfago/patologia , Doenças do Esôfago/terapia , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Esofagoscopia , Ácido Glucurônico/administração & dosagem , Hemostáticos/administração & dosagem , Ácidos Hexurônicos/administração & dosagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Excisão de Linfonodo , Masculino , Melena/etiologia , Mucosa/patologia , Necrose , Nutrição Parenteral Total , Inibidores da Bomba de Prótons/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs.
