Non-occlusive mesenteric ischaemia: The prevalent cause of gastrointestinal infarction in patients with severe burn injuries

Thermal injury is associated with an increased risk of abdominal complications such as ischemia, infarction and pneumatosis intestinalis (PI). PI is characterized by gas in the intestinal wall and, when diagnosed it can signify the presence of a life-threatening condition. We present a case of a patient who survived 75% total body surface area burns complicated by ischemic bowel that initially presented as extensive PI. This patient was emergently taken to the operating room and underwent a subtotal colectomy and small bowel resection for ischemic bowel. Prompt diagnosis and successful management of the underlying condition ultimately contributed to the patient’s survival. The presence of peritonitis or abdominal distension, portomesenteric venous gas and lactic acidosis should prompt immediate surgical intervention in the post-burn period.

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“…No patient developed PI earlier than 7 days after injury. Similar results have been reported by others [ 4 ]. In the series by Huzar et al .…”

Section: Discussionsupporting

confidence: 93%

“…Burn patients with massive intestinal infarction have a mortality >75% [ 3 ]. Non-occlusive mesenteric ischemia is the most frequent cause of GI infarction in burn patients as compared to the general population, where 80% of cases are the result of occlusive mesenteric ischemia [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Survival from a 75% TBSA thermal injury complicated by bowel ischemia presenting with pneumatosis intestinalis

Caso

Barrak

Travis

et al. 2018

Journal of Surgical Case Reports

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“…210 The total body surface area burned was 48% in the NOMI group and 20% in the embolic group. 223 Those with emboli were much older and had 100% mortality.…”

Section: The Role Of Imagingmentioning

confidence: 99%

Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins

Björck¹,

Koelemay²,

Acosta³

et al. 2017

European Journal of Vascular and Endovascular Surgery

478

226

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She participated very actively in the process of developing these guidelines, in particular the important chapters on chronic arterial and venous mesenteric ischaemia. Six days after the second meeting of the task force she died unexpectedly, to our great despair and loss. We honour her dedication and scientific integrity by completing these guidelines. Among many other commitments she was a very productive reviewer and an associate editor of this journal. You can read more about Paola's important contributions to science and to the vascular community in the April 2016 issue of the European Journal of Vascular and Endovascular Surgery. 1

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“…Non-occlusive mesenteric ischaemia (NOMI) is characterised by signs of intestinal hypoperfusion without evidence of mechanical obstruction of a supplying vessel. Left untreated, it can lead to often extensive necrosis 1 which is associated with a poor prognosis even when treated rapidly. 2 The pathophysiology of this condition is incompletely understood, but low cardiac output, for example, after cardiogenic shock, and the use of vasoconstricting agents are associated.…”

Section: Introductionmentioning

confidence: 99%