Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report

Abstract

Introduction: Bilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state.

Case presentation: We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery.

Conclusion: This case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.

Figure 1.

CT scan of the abdomen and pelvis. Arrows demonstrate bilateral enlargement and hyperdensity of the adrenal glands consistent with adrenal haemorrhage.

Figure 2.

Repeat CT scan of thorax, abdomen and pelvis, five weeks after first scan. Arrows demonstrate interval liquefaction of the adrenal gland haemorrhages.