A case report of acute mesenteric ischemia post coronary artery bypass graft with concomitant aortic valve replacement

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. The incidence of post-cardiac surgery gastrointestinal emergencies ranges between 0.4-2.9% and are often of varying diagnoses. Although acute mesenteric ischemia is infrequent, it represents 10-67% of these complications and carries an overall mortality rate of almost 95% of non-surgically treated patients compared to approximately 57% of surgically treated patients. The high number of mortalities is mainly due to its protean clinical presentations resulting in a delay in diagnosis. Case Report: We report a case of acute mesenteric ischemia in a patient who had undergone coronary artery bypass graft (CABG) with concomitant aortic valve surgery. Progressive abdominal distention and rising lactate level were the features pointed towards diagnosis of mesenteric ischemia in this patient. Based on a literature search and review, we discuss on the pearls and pitfalls in the management of this case; with aim to improve the outcome of such similar case in future. Conclusion:Gastrointestinal complications post cardiac surgery should be treated aggressively. Routine utilization of risk assessment tools such as GICS scoring model; timely intervention such as lower the threshold for diagnostic laparoscopy and selective mesenteric angiography may improve the outcome of this group of patients.