Article 2 Issue 2021

UDK 616.137-005.6-083.97

ISSN 2466-2992 (Online) (2021) br.2, p. 22-26

COBISS.SR-ID 58324489

MESENTERIAL THROMBOSIS IN PATIENTS WITH DIAREAL SYNDROME

Milan Elenkov1, Dragan Mitić2, Dušica Janković3, Tatjana Mićić3, Biljana Stošić4

1General Hospital Pirot Department of Anesthesiology, 2General Hospital Pirot, Department of Radiology, 3Emergency Medical Service Niš, 4University Clinical Centre, Niš, Clinic for Anesthesia and Intensive Care

Summary:

INTRODUCTION: Acute mesenteric ischemia (AMI) is a condition due to a sudden drop in blood flow through the mesenteric vessels. Without proper and timely treatment, necrosis of the small and large intestine occurs, which leads to sepsis and potentially death. Two major areas of the colon, including splenic flexion (Griffith’s point) and rectosigmoid junction (Sudek point), are prone to ischemia. These are also known as "watershed areas" which mean the regions between the two main arteries that supply the colon. In patients with high suspicion of intestinal ischemia, CT angiography and MR angiography are initial tests. Surgery, which can be started less than six hours after the onset of symptoms, significantly increases survival.

THE AIM: is to increase the awareness of doctors about the possible cause of abdominal pain and gastroenteritis, as one of the rare but possible causes, by presenting a patient with mesenteric thrombosis.

MATERIAL AND METHODS: Case report of a patient based on the medical protocol of General Hospital Pirot.

CASE REPORT: A 73-year-old patient, due to abdominal pain lasting a few days, did not vomit and did not have a fever. He has numerous rare yellow stools, without pathological contents. The patient was hospitalized, followed by a series of unclear laboratory and diagnostic findings. After 3 days, due to worsening of the patient, he enters the operation room where there find mesenteric thrombosis that caused perforation of the intestine.

DISCUSSION: There are few papers in the available literature that talk about the causes of delay in the suspicion and diagnosis of mesenteric thrombosis. In a small number of papers, it is assumed that the delay in making a true diagnosis of AMI is primarily due to, as in this case, let's call it "a set of symptoms or disease scenarios" that primarily suggest inflammatory bowel disease, which is otherwise much more common than mesenteric thrombosis. Also, clinicians are often deceived by inconspicuous diagnostic procedures, ie findings on sonography, radiography and MSCT, where very often scanning of mesenteric blood vessels is not performed, as was the case with our patient.

CONCLUSION: This case emphasizes the importance of recognizing atypical gastrointestinal conditions, as well as considering the causes of diarrhea outside the intestinal lumen. Importantly, it points to mistakes that clinicians may be prone to in their practice. Awareness of the possibility of such errors allows clinicians to critically consider their diagnostic reasoning in severe cases and reduce diagnostic delay,

Keywords: Acute mesenteric ischemia

Korespondencija/Correspondence

Milan ELENKOV

General Hospital Pirot

e-mail: melenkov80@gmail.com