A case of septic shock and ARDS associated with nonperforating appendicitis

We report a rare case of septic shock and acute respiratory distress syndrome (ARDS) associated with non-perforating appendicitis. A Japanese man in his 30s diagnosed with acute nonperforating appendicitis, treated conservatively with antibiotics upon admission, suffered severe septic shock the next day, necessitating emergency appendectomy. The appendix was gangrenous but not perforated macroscopically. After surgery, the patient suffered severe ARDS. He was treated with mechanical ventilation and endotoxin absorption therapy using polymyxin B-immobilized fiber direct hemoperfusion (PMX-DHP), enabling him to recover from sepsis and ARDS. Nonperforating appendicitis with severe sepsis are very rare, and only 7 cases, including our, have been reported in Japanese literature. It may thus be important to recognize the existence of nonperforating appendicitis with severe sepsis or ARDS.