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• W2912852434 abstract "Figure: Picture on the left demonstrates CT imaging of SMA thrombosis. Picture on the right demonstrates mesenteric angiogram showing SMA thrombosis.Mesenteric ischemia is defined as a loss of blood flow to the mesenteric vasculature. Acute presentations can be dramatic, leading to metabolic derangements, bowel necrosis, sepsis, and death. We present a case of mesenteric ischemia associated with endocarditis with normal laboratory values, yet dramatic intra-operative findings. A 50-year-old man was admitted to the hospital with abdominal pain. The pain was diffuse, sharp, and associated with increasing distension, dark coffee ground emesis, and inability to pass flatus. He also reported 2 weeks of fevers, night sweats, and weight loss. His physical exam was notable for tachycardia, low grade temperature of 100.6 degrees Fahrenheit, poor dentition, diffuse abdominal tenderness and distension. Initial laboratory data included normal electrolytes, renal function, liver chemistries, and lactic acid. CT scan of the abdomen showed pneumatosis of the duodenum and jejunum and dilated small bowel loops without any evidence of free air. A nasogastric tube was placed to intermittent low wall suction for decompression. On hospital day 2, gram stain on the blood cultures showed gram positive cocci in chains. An echocardiogram showed a 1.2 x 2 cm vegetation on the mitral valve with resultant severe mitral regurgitation. A CT angiogram and subsequent mesenteric angiogram were performed which showed an obstructive thrombus in the mid to distal superior mesenteric artery (SMA). He was taken for an exploratory laparotomy which showed diffusely necrotic bowel and a clot in the mid SMA. 185 cm of small bowel were removed along with the ascending colon. He had a lengthy recovery and remains dependent on paternal nutrition. Acute mesenteric ischemia is a dramatic and serious entity with a mortality risk reported as high as 60%. Lactic acidosis can arise from tissue hypoperfusion, and thus, it is thought classically that bowel ischemia will present with an elevated lactate. However, several studies have shown that early ischemia does not correlate with elevated lactate levels. Rather, transmural infarction and necrosis is where elevated lactate levels are typically seen. A few case reports have shown profound necrotic bowel but normal lactate levels, which is hypothesized to occur due to a high hepatic capacity for clearance. We present such a case with a dramatic clinical presentation, yet normal laboratory values but still resulted in necrotic bowel. Prompt recognition and management is crucial for improved outcomes.Figure: Echocardiogram demonstrating mitral valve vegetation.Figure: Operative specimen demonstrating necrotic small bowel." @default.
• W2912852434 created "2019-02-21" @default.
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• W2912852434 date "2017-10-01" @default.
• W2912852434 modified "2023-09-27" @default.
• W2912852434 title "Total Eclipse of the Gut: A Case of Mesenteric Ischemia From Endocarditis" @default.
• W2912852434 doi "https://doi.org/10.14309/00000434-201710001-02469" @default.
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