A Case of Septic Shock and ARDS Associated with Nonperforating Appendicitis

Hiroya Takeuchi¹⁾²⁾, Kohei Yonezawa¹⁾, Shiei Kim¹⁾, Atsushi Shimada¹⁾, Takashi Oishi¹⁾, Yoh Isobe¹⁾, Shunji Ikeuchi¹⁾, Kiyoshi Kubochi¹⁾, Masaki Kitajima²⁾ and Sumio Matsumoto¹⁾

Department of Surgery, National Hospital Organization Tokyo Medical Center¹⁾
Department of Surgery, Keio University School of Medicine²⁾

We report a rare case of septic shock and acute respiratory distress syndrome (ARDS) associated with nonperforating appendicitis. A Japanese man in his 30s diagnosed with acute nonperforating appendicitis, treated conservatively with antibiotics upon admission, suffered severe septic shock the next day, necessitating emergency appendectomy. The appendix was gangrenous but not perforated macroscopically. After surgery, the patient suffered severe ARDS. He was treated with mechanical ventilation and endotoxin absorption therapy using polymyxin B-immobilized fiber direct hemoperfusion (PMX-DHP), enabling him to recover from sepsis and ARDS. Nonperforating appendicitis with severe sepsis are very rare, and only 7 cases, including our, have been reported in Japanese literature. It may thus be important to recognize the existence of nonperforating appendicitis with severe sepsis or ARDS.

Key words
nonperforating appendicitis, sepsis, ARDS

Reprint requests
Hiroya Takeuchi Department of Surgery, Keio University School of Medicine
35 Shinanomachi, Shinjuku-ku, 160-8582 JAPAN

Accepted
March 28, 2007

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