Bacterial Peritonitis Occurring after Recovery from Severe Accidental Hypothermia

• Published in: Nihon Kyukyu Igakukai Zasshi 1997/09/15, Vol.8(9), pp.395-400
• Main Authors: Tsushima, Kenji, Koyama, Shigeru, Chino, Masaaki, Akahane, Kunio, Ichiyoshi, Takeo
• Format: Article
• Language: English
• Subjects: active core rewarming; bacterial peritonitis; extracorporeal circulation; severe accidental hypothermia
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.8.395

We present the case of a patient who suffered accidental hypothermia. The patient's rectal temperature was 25°C on arrival. She showed disturbance of consciousness (JCS III-200) and circulatory shock due to the hypothermia. We attempted treatment by intravenous administration of heated fluids and irrigation of the stomach with warm physiological saline. Although within the next 12 hours her body temperature gradually normalized, she suffered multiple organ failure and developed bacterial peritonitis. She died of adult respiratory distress syndrome, bacterial peritonitis and sepsis caused by Pseudomonas aeruginosa. Prolonged hypothermia accelerated coagulatory system due to hypotension, dehydoration, microscopic circulatory failure, acceleration of blood viscosity and disseminated intravascular coagulation. Several techniques of active core rewarming are reported. Rapid rewarming is the most important of all to prevent thrombosis. Therefore for the non-arrested patient who has a temperature less than 30°C, extracorporeal circulation seems to be the technique of choice, for the arrested patient without trauma, cardiopulmonary bypass seems to be the technique. These treatments prevent complications after recovery from hypothermia.