Key result
Serial echo and invasive hemodynamics guide vasoactive support in mixed shock from stercoral colitis.
Why the study?
Shock in sepsis is predominantly vasodilatory, but concomitant myocardial dysfunction may result in superimposed cardiogenic shock and a mixed shock state.
Case Report (n=1)
In patients with septic shock from stercoral colitis, serial echocardiographic and invasive hemodynamic assessments are critical to identify concomitant acute myocardial dysfunction and guide dynamic circulatory support.
Answers are grounded in this paper and cite their sources.
Supports evaluation for cardiogenic overlay in refractory septic shock; leaves open optimal diagnostic strategies in mixed shock.
BACKGROUND: Shock in sepsis is predominantly vasodilatory; however, concomitant myocardial dysfunction may result in superimposed cardiogenic shock and a mixed shock state. CASE SUMMARY: A 75-year-old man with Parkinson disease, severe constipation, and stercoral colitis presented with profound shock after an enema. Echocardiography showed new biventricular dysfunction with regional wall-motion abnormalities. Invasive hemodynamic assessment demonstrated elevated filling pressures, low cardiac index, and low systemic vascular resistance despite substantial vasoactive and inotropic support, consistent with a mixed vasodilatory and cardiogenic shock. He improved after antibiotics and vasoactive support, but manual disimpaction after stabilization was followed within minutes by recurrent/similar shock. REVIEW SUMMARY: This case illustrates a practical approach to mixed shock with acute myocardial dysfunction. Treatment of underlying infection should occur in parallel with characterization of the hemodynamic phenotype. Serial echocardiography and invasive hemodynamic assessment can identify concomitant vasodilatory and cardiogenic shock and guide circulatory support as shock physiology evolves. TAKE-HOME MESSAGES: Shock physiology is dynamic. In patients with sepsis, serial clinical, echocardiographic, and hemodynamic reassessment can identify concomitant cardiogenic shock and guide circulatory support.
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Parsa et al. (2026) conducted a case report in Mixed vasodilatory and cardiogenic shock with acute myocardial dysfunction in stercoral colitis (n=1). Serial echocardiography, invasive hemodynamic assessment, antibiotics, and vasoactive/inotropic support was evaluated on Hemodynamic stabilization and characterization of shock phenotype. Serial echocardiography and invasive hemodynamic assessment identified mixed vasodilatory and cardiogenic shock in a 75-year-old man with stercoral colitis, guiding vasoactive support.
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