Abstract
Mesenteric infarction is a surgical emergency presenting as acute abdomen. Here we present a case of unexpected diagnosis of acute mesenteric infarction. He underwent emergency laparotomy with resection of the gangrenous bowel and end- end anastomosis of remaining 140 cm small bowel left. In two weeks period patient develop recurrence of disease which was successfully managed with conservative treatment. Further detailed investigation revealed the bizarre arterial anatomy with occlusion at multiple sites.Nepalese Medical Journal, vol.1, No. 1, 2018, Page: 48-50
Highlights
Mesenteric ischemia is a surgical emergency but is an uncommon cause of acute abdomen, affecting 1 in 1000 admission cases.[1]
Mesenteric ischemia is not common with incidence of 0.1 to 1 per 1000 admissions in hospital and 1 per 100 admissions among acute abdomen based on source of information.[2,5]
In some no risk cases mesenteric ischemia leading to gut infarction can occur as first episode in our case and it is classified as non-occlusive mesenteric ischemia(NOMI).[6]
Summary
Mesenteric ischemia is a surgical emergency but is an uncommon cause of acute abdomen, affecting 1 in 1000 admission cases.[1]. We present the case of on table diagnosis of mesenteric infarction in provisionally diagnosed case of acute appendicitis He had undergone resection and anastomosis of gangrenous bowel and encountered second episode of mesenteric thrombosis during recovery period and managed successfully conservatively. This case is presented to highlight the possible rarity of the etiology of acute abdomen in the surgical field as challenge in diagnosis and management. On 13th post-operative day he again developed the signs and symptoms of bowel ischemia suggesting relapse of mesenteric ischemia. His laboratory investigations including coagulation profile repeated and were normal. Patient improved clinically and later discharged after full recovery and doing well
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