A Case of Acute Appendicitis with Onset of Clinical Scenario 1 Heart Failure After Emergency Surgery That Necessitated Intensive Care Management：A Case Report

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  • Murotani Tomotaka
    Department of Surgery, Japanese Red Cross Wakayama Medical Center Department of Trauma Emergency, Japanese Red Cross Wakayama Medical Center Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center Department of Intensive Care, Japanese Red Cross Wakayama Medical Center
  • Yamada Masaki
    Department of Surgery, Japanese Red Cross Wakayama Medical Center
  • Higashide Yasuhiro
    Department of Surgery, Japanese Red Cross Wakayama Medical Center Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center Department of Intensive Care, Japanese Red Cross Wakayama Medical Center
  • Masuda Mitsuru
    Department of Surgery, Japanese Red Cross Wakayama Medical Center Department of Trauma Emergency, Japanese Red Cross Wakayama Medical Center Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center
  • Miyamoto Takumi
    Department of Surgery, Japanese Red Cross Wakayama Medical Center

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Other Title
  • 緊急手術後にClinical Scenario 1心不全を発症し集中治療を要した急性虫垂炎の1例
  • キンキュウ シュジュツゴ ニ Clinical Scenario 1 シンフゼン オ ハッショウ シ シュウチュウ チリョウ オ ヨウシタ キュウセイ チュウスイエン ノ 1レイ

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Abstract

<p>A 51-year-old man presented to our emergency department complaining of epigastric discomfort and a sensation of abdominal fullness. He was diagnosed as having acute appendicitis, and we performed emergency laparoscopic appendectomy. The blood pressure（BP）of the patient was found to be high（systolic BP 160 mmHg）prior to the surgery, however, no antihypertensive treatment was administered, and the surgery was conducted under general anesthesia. The BP continued to increase intraoperatively and was as high as 200 mmHg in the immediate postoperative period. His blood oxygen saturation level decreased significantly to 79％, necessitating reintubation. Chest radiography revealed bilateral infiltrative opacities in the lung fields, indicative of pulmonary edema, and blood-tinged frothy secretions were observed. The patient was diagnosed as having developed flash pulmonary edema associated with Clinical Scenario 1（CS1）heart failure, necessitating postoperative intensive care. We present a rare case of acute appendicitis in a patient who developed CS1 heart failure after emergency surgery, presumably because the poorly controlled postoperative pain led to sympathetic-mediated increase in the cardiac afterload.</p>

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