首页|Bedside emergency surgical decompression and venoarterial extra-corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy-induced arrest:A case report

Bedside emergency surgical decompression and venoarterial extra-corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy-induced arrest:A case report

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Background:Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients.Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra-corporeal membrane oxygenation(ECMO).In cases where obstructive uropathies lead to urosepsis,emergent decompression with double-J(D-J)stenting may be necessitated.Case Presentation:We report the case of a 72-year-old woman who arrived at the emergency department and rapidly deteriorated into a state of shock.During the process of resuscitation,emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction.She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation.Given the suspected diagnosis,it was decided that an emergent bedside digital disposable flexible ureteroscopy(ddFURS)and D-J catheterization to be performed as rescue decompression procedure.The patient was suc-cessfully stabilized with received antibiotic and continuous renal replace-ment therapy(CRRT)before being transferred to the cardiology department to correct her arrhythmia.She was weaned off CRRT and was able to walk without the need of aids upon discharge.Conclusion:Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure.Emergent decompression with ddFURS and D-J stenting can be performed effectively even in a patient with venoarterial ECMO for res-cuing uroseptic cardiomyopathy-induced arrest secondary to obstructive uropathy.Short-term outcomes were favorable.However,long-term prog-nosis remains to be elucidated.

case reportextracorporeal membrane oxygenationseptic cardiomyopathyurosepsisurological surgery

Lin Xiong、Xiang Xu、Kristine J.S.Kwan、Richard K.Lo、Xu Li

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Department of Urology,The University of Hong Kong-Shenzhen Hospital,Shenzhen,China

Department of General Surgery,The University of Hong Kong-Shenzhen Hospital,Shenzhen,China

Department of Vascular Surgery,Fudan University Pudong Medical Center,Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling,Shanghai,China

Intensive Care Unit,The University of Hong Kong-Shenzhen Hospital,Shenzhen,China

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2024

10.1002/uro2.78

精准泌尿学(英文)

精准泌尿学(英文)

ISSN：
年,卷(期)：2024.2(3)