Difficulty Diagnosis of a Lethal Gastrointestinal Complication after Cardiac Surgery: Ischemia Bowel Combined with Gastrointestinal Hemorrhage

Abstract

Gastrointestinal complications following cardiac surgery are uncommon. However, among these complications, that with the highest incidence rate is gastrointestinal hemorrhage, whereas the highest mortality rate is associated with acute mesenteric ischemia. Here, we report a case of coronary artery disease which received coronary artery bypass grafting surgery. Following the patient's discharge from our hospital, gastrointestinal hemorrhage was noted. The clinical presentations were hematemesis and melena. The treatment of gastrointestinal hemorrhage entails adequate resuscitation and panendoscopy for hemostasis. It is also necessary to closely monitor indicators of the invasive treatment such as unstable hemodynamic status, blood transfusion requiring more than 5 units, and rebleeding after treatment. Owing to the coexistence of acute mesenteric ischemia and gastrointestinal hemorrhage in this patient, the treatment modality of gastrointestinal hemorrhage made the diagnosis of acute mesenteric ischemia more difficult and more time consuming (due to the symptoms and signs of gastrointestinal hemorrhage). Consequently, without early awareness and prompt treatment, such as laparotomy or endovascular management, mortality in patients with similar multiple conditions will increase dramatically. From a review of the literature, and on the basis of our experience, we have come to recognize the important role played by multi-detector row computed tomography (MDCT) angiography in diagnosing this difficult condition. The patient in the present study had gastrointestinal hemorrhage with unstable hemodynamic status after adequate resuscitation and angiography with endovascular treatment had been indicated, MDCT angiography enabled identification of the site of bleeding and also detected the poor circulation status of the bowel wall (this finding implying the poor mesenteric circulation). In order to improve the difficult diagnosis and high mortality associated with the type of condition observed in this patient, we suggest early MDCT angiography since it is both non-invasive and is able to detect multiple conditions.