エンドトキシン吸着療法が著効した急性閉塞性化膿性胆管炎による敗血症性ショックの1例

Abstract

We present here a case of septic shock caused by acute obstructive suppur- ative cholangitis treated successfully with endotoxin absorption therapy. A 75-year-old man was admitted to our hospital due to high-grade fever and right hypochondralgia. His consciousness was not alert and incontinence was observed. Abdominal ultrasonography revealed that the stone was incarcerated into the common bile duct. Furthermore, he exhibited the Reynolds pentad. He was, therefore, diagnosed as having acute obstructive suppurative cholangitis. Although he was treated with endoscopic naso-biliary drainage, he did not recover from septic shock. Therefore, endotoxin adsorption therapy using a column containing polymyxin B immobilized fiber (PMX) was applied. Serum levels of endotoxin and inflamation-related mediators, such as interleukin-6 (IL-6), IL-8, IL-10, tumor ne- crosis factor-α, plasminogen activator inhibitor and adrenomedullin, were decreased markedly at the completion of the PMX treatment. Furthermore, hemodynamics were also improved markedly by the PMX treatment. Our experience indicates that endotoxin adsorption therapy using PMX is useful for the treatment of septic shock caused by acute obstructive suppurative cholangitis.