Recognition and management of hemorrhaging in combination with emerging enterogenic sepsis during a hepatectomy：a case report

Abstract

BACKGROUND: Patients with hemorrhagic shock may develop emerging enterogenic sepsis due to damage to the intestinal mucosal barrier and translocation of intestinal bacteria and endotoxins caused by ischemic injury. Because of the dual effects of anesthesia state and hemorrhagic shock, perioperative emerging enterogenic sepsis is even more rare and insidious. Case presentation: We reported a case of 56-year-old man who underwent right hepatectomy for intrahepatic bile duct stones. Severe hemorrhage occurred during the procedure and the hemodynamics neither improved nor worsened after rehydration therapy and vasoactive drug administration. Based on the patient's history and clinical presentation, a possible enterogenic sepsis was considered. After anti-infective treatment and hormone supplementation, the patient's circulation improved significantly and he had an uneventful recovery. Conclusion: The possibility of emerging enterogenic sepsis in hemorrhagic shock must always be taken into consideration. Familiarity with the risk factors and pathophysiological alterations of enterogenic sepsis is a prerequisite for early recognition and sound clinical decision making.

Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report

“…However, intestinal obstruction and the associated increased abdominal pressure (IAP) can affect not only the function of vital organs, but also the integrity of the intestinal mucosa [4]. The most serious consequence of damage to the intestinal mucosal barrier is the translocation of intestinal bacteria and endotoxins into the bloodstream [4,5]. Sepsis may develop as a result, exacerbating the progression of multiple organ dysfunction syndrome.…”