Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from China's Mainland

We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.

Effect of increased intra-abdominal pressure and decompressive laparotomy on aerated lung volume distribution

Increased intra-abdominal pressure(IAP) is common in intensive care patients,affecting aerated lung volume distribution.The current study deals with the effect of increased IAP and decompressive laparotomy on aerated lung volume distribution.The serial whole-lung computed tomography scans of 16 patients with increased IAP were retrospectively analyzed between July 2006 and July 2008 and compared to controls.The IAP increased from(12.1±2.3) mmHg on admission to(25.2±3.6) mmHg(P<0.01) before decompressive laparotomy and decreased to(14.7±2.8) mmHg after decompressive laparotomy.Mean time from admission to decompressive laparotomy and length of intensive-care unit(ICU) stay were 26 h and 16.2 d,respectively.The percentage of normally aerated lung volume on admission was significantly lower than that of controls(P<0.01).Prior to decompressive laparotomy,the total lung volume and percentage of normally aerated lung were significantly less in patients compared to controls(P<0.01),and the absolute volume of non-aerated lung and percentage of non-aerated lung were significantly higher in patients(P<0.01).Peak inspiratory pressure,partial pressure of carbon dioxide in arterial blood,and central venous pressure were higher in patients,while the ratio of partial pressure of arterial O2 to the fraction of inspired O2(PaO2/FIO2) was decreased relative to controls prior to laparotomy.An approximately 1.8 cm greater cranial displacement of the diaphragm in patients versus controls was observed before laparotomy.The sagittal diameter of the lung at the T6 level was significantly increased compared to controls on admission(P<0.01).After laparotomy,the volume and percentage of non-aerated lung decreased significantly while the percentage of normally aerated lung volume increased significantly(P<0.01).In conclusion,increased IAP decreases total lung volume while increasing non-aerated lung volume.Decompressive laparotomy is associated with resolution of these effects on lung volumes.

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Gastrointestinal bleeding due to aortoenteric fistula is extremely rare.Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality.Herein,we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula,which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago.An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum,but a prolonged shock led to the patient's death.In summary,early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.