Urinary Bence Jones protein was negative and C‐1 esterase inhibitor level was low (Table 1). We conducted blood tests, which revealed increased level of kappa light chain M protein (9.6 mg/dL). In addition, the serum albumin level was extremely low (0.7 mg/dL), due to which we suspected CLS for the first time. Although her condition was initially attributed to uncontrolled sepsis, her C‐reactive protein level, white blood cell count, and procalcitonin level had improved on the third postoperative day moreover, no bacteria were detected in the postoperative culture specimens. On the 3rd postoperative day, it was not possible to reduce the amount of the fluid, and we had to increase the infusion to 1000 mL/h. The infusion volume was therefore again increased to 500 mL/h. By the 2nd postoperative day, the infusion could be reduced to 100 mL/h however, after a while, the blood pressure began to decrease. The day after the operation, the infusion was 200 mL/h. Based on the data provided by the EV1000 ®, especially the global end‐diastolic volume index (GEDI), up to 17 hours after the operation, we gradually reduced the infusion volume. We were using the EV1000 ® (Edwards Life Science, Ltd) for hemodynamic monitoring. Therefore, 7 hours after the operation, continuous administration of hydrocortisone (200 mg/day) and continuous hemodiafiltration (CHDF) were introduced. The blood pressure started dropping 5 hours after the operation the fluid volume was increased to 500 mL/h, but the blood pressure did not rise. Table 1 shows the blood test parameters on admission to the ICU.
Meropenem 3g/day and daptomycin 350mg/day were used as antibiotics. Her vital signs were as follows: body temperature 35.8☌, blood pressure 108/65 mm Hg, pulse 122/min, respiratory rate 15/min under sedation. Extracellular fluid was administered at 200 mL/h, and noradrenaline was administered at 0.3 γ. She underwent a right hemicolectomy and ileostomy through open surgery.Īfter surgery, she was admitted to the intensive care unit (ICU), where she was orally intubated and ventilated. She was immediately taken in for emergency surgery.
#OMORI LEAKS FREE#
The CT scan was re‐examined, and free air was found in the abdominal cavity. She complained of feverishness and a severe stomachache that night. Three days later, she underwent colon stenting with an endoscope. On admission, computed tomography (CT) showed ascending colon cancer. She was a known case of myasthenia gravis she had undergone thymoma extraction 6 years ago, after which she had started taking prednisolone 6mg/day and tacrolimus 3mg/day. Moreover, we obtained new information about this condition during the course of treatment.Īn 84‐year‐old woman was admitted to the general ward of our hospital with the chief complaints of stomachache and diarrhea. We present a case of CLS that developed after surgery for colon cancer perforating peritonitis wherein we treated the patient with plasma filtration with dialysis (PDF). Various treatments have been attempted, including fluid resuscitation, renal replacement therapy, corticosteroid administration, high‐dose intravenous immunoglobulin (IVIG), and plasma exchange (PE). The characteristics of CLS are hypotension, hemoconcentration, and low plasma albumin levels however, there are no clear diagnostic criteria.Ĭertain autoimmune systems may be involved in the disease.
#OMORI LEAKS PDF#
Thus, PDF might be useful in such cases.Ĭapillary leak syndrome (CLS) is a very serious condition of unknown cause, first reported by Clarkson in 1960. PDF ameliorated the capillary leak, and the patient's blood pressure gradually increased. We treated the patient with plasma filtration with dialysis (PDF). We present a case of capillary leak syndrome in a patient who underwent surgery for colon cancer‐associated perforating peritonitis.
0 kommentar(er)
