A case of sepsis complicated by multiple organ dysfunction syndrome with CT appearance of subarachnoid hemorrhage.

Abstract

A 39-year-old male patient was admitted to hospital with abdominal distension, unconsciousness, and anuria. Head computed tomography (CT) scan showed subarachnoid hemorrhage and diffuse cerebral edema. The high-density area of contrast accumulation region in the high-density CT plaque was 38 HU, and the preliminary diagnosis was SAH, incomplete intestinal obstruction, and sepsis caused by acute cerebrovascular disease. After admission, the patient had sudden upturned eyes, limb convulsions, serum procalcitonin level exceeding 100ng/mL, low blood pressure and septic shock. Imipenem was given for intensive anti-infection therapy. After treatment, the procalcitonin levels showed a slow decline, renal function returned to normal, intra-abdominal pressure dropped to normal, urine volume gradually increased, but platelets still showed a downward trend. The lumbar puncture showed colorless and clear cerebrospinal fluid, and the biochemical and routine results of cerebrospinal fluid were normal. SAH and intracranial infection were excluded, and it was considered that the head CT scan showed pseudo subarachnoid hemorrhage. On the 4th day of admission, laparoscopic exploratory laparotomy+appendectomy+abdominal drainage under general anesthesia were performed. During the operation, purulent gangrene was observed in the appendix, abscess and moss were observed on the surface of the intestine, and a large amount of pus was found in the abdominal cavity. Rhabdomyolysis syndrome appeared after surgery. After continuous renal replacement therapy, the indicators gradually returned to normal level. The patient was conscious, and the head CT examination was normal. The patient was discharged from the hospital on the 10th day after surgery, and no special discomfort and abdominal pain and distension occurred during the 3-month follow-up.