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2018 ; 2018
(ä): 5248901
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Hemoadsorption in a Case of Severe Septic Shock and Necrotizing Fasciitis Caused
by Nontraumatic Renal Rupture due to Pyelonephritis with Obstructive Uropathy
#MMPMID29854478
Kousoulas L
; Wittel U
; Fichtner-Feigl S
; Utzolino S
Case Rep Crit Care
2018[]; 2018
(ä): 5248901
PMID29854478
show ga
BACKGROUND: Nontraumatic renal rupture due to pyelonephritis with obstructive
uropathy is an uncommon but life-threatening situation. CASE PRESENTATION: A
25-year-old female presented to the emergency department with acute worsening of
abdominal pain that began four weeks earlier. She was found to have peritonitis,
leukocytosis, severe lactic acidosis, and a pronounced anemia and imaging was
consistent with nontraumatic renal rupture with retroperitoneal abscess,
perforation of the colon, and severe necrotizing fasciitis of the right lower
limb. She underwent a right nephrectomy, a right hemicolectomy, surgical
debridement of the retroperitoneum, and an upper thigh amputation. Due to severe
septic shock and rhabdomyolysis with acute renal failure we performed a combined
treatment of hemoadsorption using a Cytosorb hemoadsorber and continuous
venovenous hemodialysis (CVVHD). Subsequently the patient recovered and was
discharged home with no signs of infections and with normal renal function.
CONCLUSION: We present a case of pyelonephritis with nontraumatic renal rupture
leading to necrotizing fasciitis with osteomyelitis of the lower limb. The early
treatment of the patient with a Cytosorb hemoadsorber led to a rapid hemodynamic
and metabolic stabilization and preservation of the renal function, suggesting
that hemoadsorption might be a rescue therapy in patients with severe septic
shock and traumatic rhabdomyolysis.