Can the fate be cheated? Septic shock in the course of an abdominal multi-organ trauma – a case report

Dear Editor,
Septic shock is a life-threatening condition. The mortality rate for septic shock amounts to 50% [1], the percentage that has been remaining at this high level for years [2, 3]. The Surviving Sepsis Campaign took the initiative to publish the updated guidelines for optimal diagnostic and therapeutic management of sepsis [4].
A 43-year-old man had an accident during wood cutting with a circular saw. He sustained a chest injury at the level of the right costal arch caused by a tooth broken off from the circular saw (about 30 × 7 mm in diameter). The patient was transported to the nearest Accident and Emergency Department where he underwent computed tomography (CT), which visualized an interstitial hepatic haematoma, an epigastric haematoma, duodenal perforation and possible splenic marginal rupture. Moreover, the CT scan revealed a metallic foreign body located in the region of the left common femoral vein (Figure 1). The patient was emergently transferred to the operating suite of the Department of General Surgery. During laparotomy the haematoma was evacuated from the peritoneal cavity of the epigastric region, which was followed by duodenorrhaphy with single sutures, local haemostasis, and insertion of a drain into the area of duo­denal injury. Due to haemodynamic instability associated with haemorrhagic shock, the evacuation of the foreign body was abandoned. On post-injury day 6, due to signs of alimentary tract perforation, relaparotomy was required, which revealed the necrotically-altered duodenal wall. Single sutures were placed within the necrotic area. Moreover, the injury to the extrahepatic biliary tract was recognised. Once the telephone consent was obtained, the patient was referred to the Department of Gastrointestinal Surgery and transferred to the Department of Anaesthesiology and Intensive Care for further treatment.
On ICU admission, the patient’s condition was relatively fair; he was conscious and in logical contact, under opioid analgesia, his respiration was efficient while circulation inefficient but stable (noradrenaline in a dose of 0.09 µg kg-1 min-1). On day 8, follow-up CT was performed, which confirmed duodenal perforation and presence of fluid in the abdominal cavity. Emergency relaparo­tomy was undertaken. Within the next two hours, the patient developed the symptoms of shock: he was confused, periodically excited, with increasing respiratory failure (tachypnoea, dyspnoea) and circulatory failure...


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