A 50-year-old woman, diabetic, hypertensive and dyslipidemic, presented in the emergency department of HUAP with diffuse abdominal pain.
Tachypnea, tachypnea and poorly perfused are described.
A CT scan of the abdomen and pelvis showed significant colonic ileus with no signs of mechanical obstruction or hollow viscera perforation, which was interpreted as Ogilvie syndrome.
Antibiotic treatment was initiated with ceftriaxone and metronidazole.
The patient progresses in poor conditions, requiring orotracheal intubation, mechanical ventilation (MV) and NA.
Evaluated by surgical team and in the presence of acute abdomen it was decided to enter the pavilion.
The surgical protocol describes a large amount of purulent fluid (± 400 cc), necrosis of all segments of the colon, so a total colectomy and terminal ileostomy are performed, sibling with laparotomy and installation.
She was admitted to the ICU with a diagnosis of abdominal sepsis, colon necrosis of unknown etiology, laparotomy and DOM.
Target-directed resuscitation and advanced life support were performed10,15.
Extended MDH associated with Cytosorb was initiated 16 h after ICU admission.
The patient improved hemodynamically within 9 h of starting therapy and DA could be removed at 19 h, when the NA had decreased from 0.6 at admission to 0.12 μg/kg/min.
On the 6th day she was successfully extubated.
During her stay in the ICU, the patient underwent three surgical silks before closing the laparotomy.
Throughout its evolution, diuresis was maintained between 430 and 1,005 mL/day, requiring MDH until day 28 of hospitalization.
The demographic variables, days of stay at IMV, ICU and ICU are described in Table 1.
IMV: invasive mechanical ventilation; ICU: intensive care unit; ICU: intermediate care unit.
