Acute mesenteric ischemia is a state in which intestinal infarction can be caused by a sudden decrease in blood flow. A 68-year-old man was transferred to Hanyang University Guri hospital with abdominal pain. A computed tomography scan performed before the transfer showed no abnormal findings. Examination and evaluation revealed abnormal electrocardiogram findings and increased troponin I. Although emergency coronary angiography was normal, the patient continued to complain of severe abdominal pain. A computed tomography scan showed occlusion of the superior mesenteric artery. Percutaneous aspiration embolectomy was successfully performed prior to surgery, and subsequent laparoscopic exploration revealed an area of bowel necrosis which was then resected. The length of the small intestine remaining after resection measured 1.6 m. On postoperative Day 6, the patient began a soft food diet and was prescribed medication after being diagnosed with atrial fibrillation. He was discharged on the 13th postoperative day without postoperative complications.

Purpose
Polymyxin B hemoperfusion (which treats septic shock by removing endotoxins of gram-negative bacteria), has been proposed as a treatment modality for intraabdominal sepsis. However, there are few studies about the factors that need to be taken into consideration for a better outcome. The aim of this study was to assess the effectiveness of polymyxin B hemoperfusion in abdominal septic shock and analyze the factors affecting the outcome of this therapy.
Methods
A retrospective review was performed in 41 patients who were diagnosed with abdominal septic shock. There were 12 patients treated with polymyxin B hemoperfusion, and 29 patients treated with conventional therapy. The clinical outcomes of the 2 groups were compared to identify the factors affecting the outcome of hemoperfusion.
Results
The decrement of vasopressor requirement represented by vasopressor dependency index was 2.5 in the hemoperfusion group and 0.1 in the conventional therapy group (p = 0.021), and in-hospital mortality was 33.3% in the hemoperfusion group and 69.0% in the conventional therapy group (p = 0.045). In logistic regression analysis, hemoperfusion was identified as a factor reducing in-hospital mortality in patients with sufficient source control, but not in patients with insufficient source control. In patients who had undergone hemoperfusion, the longer time to initiate hemoperfusion was identified as a risk factor of in-hospital mortality (p = 0.039).
Conclusion
Polymyxin B hemoperfusion may be an effective therapy for treating abdominal septic shock, and early use of this modality with definite source control might be important for a better outcome.

Citations

• The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP
  Hye Sung Kim, Yoon Ji Chung, Gyeo Ra Lee, Eun Young Kim
  Frontiers in Medicine.2024;[Epub]     CrossRef
• Potential survival benefit and early recovery from organ dysfunction with polymyxin B hemoperfusion: perspectives from a real-world big data analysis and the supporting mechanisms of action
  Hisataka Shoji, Ricard Ferrer
  Journal of Anesthesia, Analgesia and Critical Care.2022;[Epub]     CrossRef