title: Ischemic necrosis of the tongue in surgical patients with septic shock: a case report.
abstract: BACKGROUND
  As the tongue is a well-vascularized organ, ischemic necrosis of the tongue is a rare disease entity. Critically ill patients with profound shock may experience end-organ hypoperfusion, which might result in tongue necrosis. However, to our best knowledge, there are no reports regarding ischemic necrosis of the tongue in surgical patients with septic shock.
  
  
  METHODS
  Two patients recently developed ischemic necrosis of the tongue in our surgical intensive care unit. Both patients had undergone emergent surgery for ischemic enteritis and developed postoperative septic shock. The first patient responded to critical treatment with a short period of circulatory shock, and the delivered dose of the vasopressor seemed to be acceptable. In contrast, the second patient developed postoperative refractory shock, and high-dose vasopressor treatment was required to maintain adequate tissue perfusion. Both patients developed ischemic necrosis of the tongue and died shortly after its emergence, despite vigorous resuscitation.
  
  
  CONCLUSIONS
  We suggest that ischemic necrosis of the tongue is an under-reported manifestation of any type of circulatory shock, which may have a complex pathogenic mechanism. Clinicians should be aware of the possibility of ischemic necrosis of the tongue in patients with circulatory shock, even if the patient exhibits clinical improvement, as this awareness may facilitate estimation of their prognosis and preparation for clinical deterioration.
authors.affiliation: Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, (420-717), Korea.
authors.forename: Jinbeom
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, (420-717), Korea.
authors.forename: Kiyoung
authors.initials: K
authors.lastname: Sung
authors.affiliation: Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, (420-717), Korea. surgeryds@gmail.com.
authors.forename: Dosang
authors.initials: D
authors.lastname: Lee
mesh_terms: D000369:Aged, 80 and over; D004751:Enteritis / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D008297:Male; D009336:Necrosis / Q000209:etiology; D012772:Shock, Septic / Q000150:complications* / Q000628:therapy; D014059:Tongue / Q000098:blood supply* / Q000473:pathology*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: Case report; Ischemic enteritis; Septic shock; Tongue ischemia; Tongue necrosis