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      Septic shock caused by acute appendicitis complicated with abscess formation within mesoappendix: A case report

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          Highlights

          • Appendicitis can cause septic shock.

          • Abscess within mesoappendix led to septic shock.

          • Appendectomy is an effective rescue therapy for acute appendicitis complicated with septic shock.

          Abstract

          Introduction

          Acute appendicitis is the most common surgical emergency and may present with a wide variety of clinical manifestations. In rare circumstances, appendicitis can cause life-threatening complications e.g. septic shock. We present a case of septic shock caused by acute appendicitis complicated with abscess formation within the mesoappendix.

          Presentation of case

          A 42-year-old male was presented with migratory right lower abdominal pain, accompanied by septic shock and acute kidney failure. We performed emergency appendectomy and unexpectedly observed an abscess within the mesoappendix during surgery. The patient received antibiotic therapy perioperatively. Escherichia coli and Klebsiella pneumoniae subspecies were isolated from the intraoperative pus specimen, and Bifidobacterium was isolated from his preoperative blood culture. Histopathology revealed acute suppurative appendicitis. The patient recovered uneventful and was discharged 5 days after surgery.

          Discussion

          We believe that the septic shock was associated with the small abscess formation in the mesoappendix. Bacteria within the mesoappendix could enter the bloodstream through the mesoappendiceal vessel and then septic shock and kidney failure occurred sequentially. We assume that the abscess within the mesoappendix was caused by a tiny perforation from the mesoappendiceal side.

          Conclusion

          The case of acute appendicitis complicated with abscess formation within mesoappendix explains one of the causes which may lead to septic shock.

          Related collections

          Most cited references 7

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          The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines

          The SCARE Guidelines were published in 2016 to provide a structure for reporting surgical case reports. Since their publication, SCARE guidelines have been widely endorsed by authors, journal editors, and reviewers, and have helped to improve reporting transparency of case reports across a range of surgical specialties. In order to encourage further progress in reporting quality, the SCARE guidelines must themselves be kept up to date. We completed a Delphi consensus exercise to update the SCARE guidelines.
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            Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.

            Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.
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              • Record: found
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              Acute appendicitis.

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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                28 September 2020
                2020
                28 September 2020
                : 76
                : 186-189
                Affiliations
                Department of Emergency General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, PR China
                Author notes
                [* ]Corresponding author. worldwidth@ 123456aliyun.com
                Article
                S2210-2612(20)30832-4
                10.1016/j.ijscr.2020.09.159
                7550827
                33038845
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Categories
                Case Report

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