Abstract
We report 6-year-old boy who developed severe vomiting with upper abdominal pain after lunch on June 26, 2007, and then abdominal distention appeared the following day. After consulting a local physician, he was referred to the pediatric division of our hospital and admitted for examination and treatment. Because the patient was in shock with a high fever and tachypnea, he was placed in ICU for total body management. Abdominal CT showed a large amount of free air and ascites, enlarged stomach, duodenum, and small intestine. Perforation of the upper digestive tract was assumed and emergent abdominal surgery was performed. Based on intraoperative findings of ascites along with a rupture on the back wall of the proximal greater curvature of the upper section of the stomach and food residue in the abdominal cavity, peritonitis due to the gastric rupture was diagnosed and partial gastric resection including the ruptured section was carried out. After surgery, the patient remained in septic shock state with a systolic blood pressure of 60mmHg despite administration of dopamine (DOA). Therefore, endotoxin adsorption using polymyxin-B immobilized fiber (PMX) was carried out. The blood pressure rapidly increased after PMX was initiated, and improved to 136/70mmHg after 2 hours. After completing PMX, treatment was switched to continuous hemodiafiltration (CHDF) and sufficient diuresis could be obtained. Three days later, both of DOA and CHDF were discontinued. The patient was discharged from ICU on July 27, and discharged from hospital on December 22. In later childhood, idiopathic gastric rupture is rarely observed, and this is the third case of septic shock treated by PMX to be reported in Japan. Consideration of the need for blood purification therapy, which includes PMX, is recommended in order to achieve early withdrawal from severe septic shock and improvement of the total body condition, even in pediatric cases.
