Cervical cord injury complicated by acute mesenteric ischemia

Abstract

Acute mesenteric ischemia is a rare, life-threatening complication of cervical cord injury. This case report emphasized the importance of prompt diagnosis and treatment of this complication. A 60-year old Japanese man with no co-morbidities was diagnosed as a C2 cervical cord injury and traumatic brain injury after a fall-down trauma. He was admitted to the intensive care unit after cord decompression surgery. Nine days later, he presented tachycardia and hypotension. Ultrasound showed dilated intestines and ascites. Intestinal ischemia was suspected based on the contrast-enhanced computed tomography scan. We performed prompt surgical resection of a broad part of the small intestines. The ischemic region of the intestines was segmental and the cause was attributed to a non-occlusive mechanism. Acute mesenteric ischemia can be fatal and a delay in diagnosis leads to poor outcomes. We focus on predisposing factors in patients with cervical cord injuries and how to prevent this serious diagnosis.

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

“…MDCTA is the best imaging modality in the diagnosis of acute mesenteric ischemia with a sensitivity of 94% and a specificity of 95% [9,18,21,22].CT protocol optimal protocol includes a multiphasic examination: non-enhanced acquisition followed by biphasic contrast-enhanced phases (delay of 30 s for the arterial phase and at 60-70 s for the venous phase). Intravenous administration of nonionic iodinated contrast material at a high flow rate at a rapid injection rate of 4-5 mL/sec, followed by a saline solution flush (1.5 mL/kg ) is administered optimizing scanning times with contrast bolus tracking methods [18,23].…”

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

“…MDCTA is the best imaging modality in the diagnosis of acute mesenteric ischemia, with a sensitivity of 94% and a specificity of 95% [ 9 , 21 , 27 , 28 ]. The optimal CT protocol includes a multiphasic examination: non-enhanced acquisition followed by biphasic contrast-enhanced phases (with a delay of 30 s for the arterial phase and at 60–70 s for the venous phase).…”