Abstract

BackgroundNon-occlusive mesenteric ischemia is not uncommon in chronic hemodialysis patients and is the major cause of an acute abdomen in this population. Intensive ultrafiltration and intradialytic hypotension are usually the precipitation factors. A definite diagnosis is usually late and associated with high mortality. We present a rare case of a patient who developed abdominal symptoms during his first week on HD without having obvious hypotensive episodes.Case presentationA 76-year-old man was admitted with pulmonary edema and renal failure developed abdominal symptoms during his first week on hemodialysis without having obvious hypotensive episodes. Abdominal diagnostic procedures were all unrevealing. Mesenteric ischemia was diagnosed during laparoscopy done on the basis of physical findings and clinical suspicion. Ischemic small bowel of the distal ileum was resected and histopathology examination of the small bowel demonstrated transmural ischemic necrosis with hemorrhages and non-occluded mesenteric artery. Patient maid a steady recovery, and was discharged on the 11th post-operative day.ConclusionMesenteric ischemia should be systematically suspected in dialysis patients experiencing even mild and nonspecific abdominal symptoms with or without hemodialysis-induced hypotensive episodes. Identification of patients at risk and prevention of intradialytic hypotension may help to reduce the incidence of this potentially fatal complication in hemodialysis patients.

Highlights

  • Non-occlusive mesenteric ischemia is not uncommon in chronic hemodialysis patients and is the major cause of an acute abdomen in this population

  • Mesenteric ischemia should be systematically suspected in dialysis patients experiencing even mild and nonspecific abdominal symptoms with or without hemodialysis-induced hypotensive episodes

  • We present a rare case of a 76-year-old man who developed abdominal symptoms during his first week on HD without having obvious hypotensive episodes

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Summary

Conclusion

Mesenteric ischemia is a potentially fatal complication in chronic HD patients and is the major cause of an acute abdomen in this population. A definite diagnosis is usually late and associated with high mortality. To our knowledge, this is a first report of NOMI that occurred at the fist week of chronic HD therapy and without hypotensive episodes. Mesenteric ischemia should be systematically suspected in patients experiencing even mild http://www.casesjournal.com/content/1/1/217 abdominal symptoms during or after HD sessions, especially in elderly patients with atherosclerotic cardiovascular disease even without HD-induced hypotensive episodes. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal

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