Granulocytic Sarcoma of Intestine

Granulocytic Sarcoma of Intestine: An Unusual Clinical Presentation at A Rare Site
Mishra Jyoti, Devdhar Sarita, Srivastav Srijan*, Suparna Dubey
Consultant and Head, Surgical ICU, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
*Corresponding author: Vishal Bhatnagar, Consultant and Head, Surgical ICU, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India.
Received: July 21, 2021; Published: August 25, 2021

Abstract
Background: Sepsis is a major cause of morbidity and mortality in modern intensive care units (ICUs). Although several studies have provided epidemiological data on sepsis in ICU patients in the developed world [1-6]. 
Objective: To illustrate the need for early intervention and consultation for added assistance to approach and rule out other possible causes during such a scenario. 
Case report: Patient presented with ulcer on posteromedial aspect of thigh since two years. Patient underwent uneventful wide local excision with skin grafting under general anaesthesia with epidural and extubated. Patient shifted to HDU for post operating monitoring. After 16 hours in post-operative period patient had hypotension, fever, Difficulty in breathing. Patient intubated and put on ventilator. IV fluid bolus given but Mean Arterial Pressure (MAP) not maintained > 65 mmHg. Patient was still hypotensive and start on inotropic support with noradrenaline. Further Vasopressin infusion also added. Fentanyl
infusion started for sedation now patient was shifted to our ICU and managed accordingly and shifted to ward on POD4.
Conclusion: Early recognition of and treatment of sepsis can significantly reduce mortality. Limitations on resources make implementation of finding of clinical trials problematic. However, the most important interventions of aggressive fluid resuscitation, oxygen and early antibiotics, with frequent review to adjust treatment, can be achieved in any hospital.

Keywords: Sepsis; Wide local excision; Hypotension; Early recognition; Case report

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