acute mesenteric ischemia and duodenal ulcer perforation a unique double pathology急性肠系膜缺血和十二指肠溃疡穿孔独特的双重病理学.pdfVIP

Haruna et al. BMC Surgery 2012, 12:21 /1471-2482/12/21 CASE REPORT Open Access Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology * Lois Haruna, Ahmed Aber, Farhan Rashid and Marco Barreca Abstract Background: Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology. Case presentation: We report a unique case of a 53 year old Italian lady who presented with acute mesenteric ischaemia and duodenal perforation. This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation. Conclusion: Early management in the intensive care unit and appropriate surgical intervention maximised the patient’s chances of survival despite the poor prognosis associated with her dual pathology. The rare pathology of the patient described can be explained by two possible hypotheses: peptic ulcer disease causing duodenal ulceration, which precipitated ischaemic infarction of the small bowel. The second hypothesis is the patient developed a stress related ulcer following ischaemic bowel infarction secondary to arterial thrombosis. Keywords: Acute mesenteric ischaemia, Duodenal ulcer perforation, Mesenteric venous thrombosis, Ischemic bowel infarction, Bowel necrosis Background emboli originate from a cardiac source. The second most Acute mesenteric ischemia (AMI) compri