Septic shock can present insidiously and lead to poor outcomes, particularly in elderly and frail patients. This case report describes a fatal instance of septic shock that occurred in temporal association with a cystostomy procedure in a patient who was long-term dependent on an indwelling urinary catheter. The authors report the clinical course to underscore risks related to delayed infection recognition before surgical interventions.
The patient was a 76-year-old man with multiple chronic conditions: hypertension, type 2 diabetes mellitus, and a prior cerebral infarction. Following his stroke, he had prolonged bed confinement and impaired levels of consciousness. One year before the events described, he developed urinary retention attributed to benign prostatic hyperplasia and therefore had a long-term indwelling urethral catheter placed.
The urethral catheter was accidentally dislodged. The patient first presented to the emergency department approximately 8 hours after the dislodgement, at about 20:30 on November 1, 2025. At that visit, clinicians recommended a cystostomy. The patient declined the procedure and left the hospital against medical advice.
He returned to the hospital the following morning at approximately 08:00 on November 2, 2025, and then consented to undergo cystostomy. During the cystostomy procedure, he acutely developed septic shock. The report attributes the severe infectious complication to delayed recognition of infection risk in the catheter-dependent, frail patient, although specific microbiology, hemodynamic parameters, or resuscitation details were not reported in the source abstract.
After developing septic shock during the procedure, the patient was transferred postoperatively to the intensive care unit for further management. The case report does not provide granular data on ICU therapies, vasopressor use, ventilatory support, laboratory results, or culture findings in the abstract. It does describe that despite escalation to critical care, the patient’s family elected to discontinue active treatment after three days in the ICU.
Following the family’s decision to stop active interventions, the patient was taken home by his relatives. Follow-up information presented in the report indicates that the patient died two days after discharge. The case was classified as a fatal outcome associated with cystostomy and delayed infection recognition.
The authors highlight several clinical implications from this case:
Early and proactive infection screening and vigilance for sepsis are essential in elderly, frail, and catheter-dependent patients prior to invasive procedures.
Recognizing signs of infection before performing procedures such as cystostomy may allow for earlier stabilization or treatment and could potentially alter perioperative risk.
Maintaining catheter patency and ensuring proper catheter and home care are important preventive measures for catheter-associated complications.
The abstract does not specify particular screening protocols, diagnostic criteria used, or antimicrobial strategies; these details were not reported in the source abstract.
This case report documents a fatal episode of septic shock that developed during a cystostomy in a 76-year-old man with multiple comorbidities and a long-term indwelling urinary catheter. The sequence of events—catheter dislodgement, delayed presentation, initial refusal of recommended cystostomy, later consent, and intraoperative development of septic shock—underscores the dangers of delayed infection recognition in high-risk, catheter-dependent patients. The authors conclude that heightened attention to early infection screening, prompt sepsis recognition before surgical interventions, unobstructed catheter management, and appropriate home care are critical to reducing the risk of severe outcomes in similar patients.
Note: The abstract provides a clinical narrative and conclusions but does not include specific microbiology results, detailed intraoperative or ICU management measures, laboratory values, or timelines beyond the dates and times noted; those details were not reported in the source abstract (PMID: 42555538; DOI: 10.12659/AJCR.952428).