Bedside emergency surgical decompression and venoarterial extra‐corporeal membrane oxygenation for obstructive uropathy with uroseptic cardiomyopathy‐induced arrest: A case report

Abstract

Background: Septic shock combined with septic cardiomyopathy greatly increases the risk of mortality in elderly patients. Patients with a rapid deteriorating state unresponsive to standard resuscitation may benefit from extra‐corporeal membrane oxygenation (ECMO). In cases where obstructive uropathies lead to urosepsis, emergent decompression with double‐J (D‐J) stenting may be necessitated.

Case Presentation: We report the case of a 72‐year‐old woman who arrived at the emergency department and rapidly deteriorated into a state of shock. During the process of resuscitation, emergent biochemical and ultrasound results suggested septicemia and septic cardiomyopathy due to urinary tract infection caused by ureteric stone obstruction. She was transferred to the intensive care unit to be put on venoarterial ECMO after failed resuscitation. Given the suspected diagnosis, it was decided that an emergent bedside digital disposable flexible ureteroscopy (ddFURS) and D‐J catheterization to be performed as rescue decompression procedure. The patient was successfully stabilized with received antibiotic and continuous renal replacement therapy (CRRT) before being transferred to the cardiology department to correct her arrhythmia. She was weaned off CRRT and was able to walk without the need of aids upon discharge.

Conclusion: Uroseptic cardiomyopathy can rapidly progress to renal and cardiac failure. Emergent decompression with ddFURS and D‐J stenting can be performed effectively even in a patient with venoarterial ECMO for rescuing uroseptic cardiomyopathy‐induced arrest secondary to obstructive uropathy. Short‐term outcomes were favorable. However, long‐term prognosis remains to be elucidated.

Keywords

case report / extracorporeal membrane oxygenation / septic cardiomyopathy / urosepsis / urological surgery

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2024 The Author(s). UroPrecision published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.