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Abstract
Bedside nurses require excellent observational and assessment skills. Being knowledgeable about common diseases that often affect the population is essential; however, it is often more challenging to be informed about life-threatening conditions that rarely develop. Such is the case with mesenteric ischemia, a rare but complicated condition, which is difficult to diagnose, carries a degree of mortality of about 40%-70%, and is more common in people older than 50 years. Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient's condition and detect clues that may assist with an accurate and prompt diagnosis. Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.
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Affiliation(s)
- Jose Canceco
- Jose Canceco, BSN, RN, Adult Gerontology Acute Care Nurse Practitioner Program, California State University, Los Angeles. Elizabeth J. Winokur, PhD, RN, CEN, Adult Gerontology Acute Care Nurse Practitioner Program, California State University, Los Angeles
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Abe S, Yamakawa T, Kawashima H, Yoshida M, Takanashi S, Kashiyama M, Ishigooka M, Shingu Y, Matsui Y. Surgery for acute exacerbation of chronic mesenteric ischemia: a case report. Surg Case Rep 2016; 2:146. [PMID: 27921277 PMCID: PMC5138179 DOI: 10.1186/s40792-016-0272-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic mesenteric ischemia (CMI) is a rare disease; however, symptomatic CMI has a risk of acute exacerbation without timely revascularization. CASE PRESENTATION A 54-year-old man who had had postprandial pain for 6 months was admitted to our hospital because of vomiting and diarrhea. Although the celiac and superior mesenteric arteries were occluded at the proximal portion, contrast enhancement of the bowel wall was good in contrast-enhanced computed tomography (CECT). Endoscopic examination revealed only a healed gastric ulcer and slight mucosal erosions in the colon. He was diagnosed as having acute enteritis or inflammatory digestive disease and observed with conservative therapy, which improved his acute symptoms. On hospitalization day 42, he suddenly complained of lower back pain. CECT showed abdominal free air, which indicated gastrointestinal perforation. Emergency surgery was performed for jejunum resection. Two days later, a second operation was performed for a leak in the anastomotic site of the jejunum. Necrotic change in the small intestinal serosa was also observed and required broad resection of the small intestine. He was diagnosed with acute exacerbation of CMI, and we performed surgical retrograde bypass to the gastroduodenal artery using a saphenous vein graft as the third operation. After the surgery, he was free from digestive symptoms and was discharged. CONCLUSIONS When patients complain of chronic and gradual digestive symptoms, we should always consider symptomatic CMI. Timely mesenteric revascularization is important for symptomatic CMI before severe complications occur.
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Affiliation(s)
- Shinji Abe
- Department of Cardiovascular Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
| | - Tomoji Yamakawa
- Department of Cardiovascular Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Hideaki Kawashima
- Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Makoto Yoshida
- Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Setsuji Takanashi
- Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Motoya Kashiyama
- Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Masahiro Ishigooka
- Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
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