Bowel ischemia in a baby with unspecified renovascular hypertension: a case report

Abstract

Introduction Renovascular hypertension due to congenital multiple visceral arterial stenoses in neonates is rare. Management is challenging and has not been standardized. Medical control of blood pressure remains the first-line therapeutic approach. However, unwise control of blood pressure in such cases may lead to disastrous situations. Case presentation We present the case of an 18-day-old Saudi girl with hypertension due to unspecified vascular occlusive disease. The hypertension was managed medically by maintaining blood pressure at ‘near normal’ levels, and this led to bowel ischemia. Our patient survived the short bowel syndrome and is now two years old. She is on full oral feeding and has reached acceptable growth parameters. Her blood pressure has stabilized at around 110/70 mmHg without anti-hypertensive drugs. She has good organ function and walks despite increased narrowing in stenotic areas and complete obliteration of her left iliac and femoral arteries as seen on follow-up computed tomography angiography. Conclusions We suggest keeping blood pressure at the highest levels permissible in similar clinical situations to prevent a state of bowel hypoperfusion. When alternative treatments for congenital multiple visceral arterial stenoses are not feasible, careful medical therapy and a waiting approach for collaterals to develop may be appropriate.