Small-intestinal necrosis due to non-occlusive mesenteric ischemia with diabetic ketoacidosis after quetiapine treatment

Spontaneous pneumoperitoneum and diabetic ketoacidosis in fulminant type 1 diabetes: a case report

A 41-year-old woman was referred to our emergency department with a 3-day history of upper abdominal pain. We diagnosed her with diabetic ketoacidosis (DKA) after laboratory tests indicated a blood glucose level of 569 mg/dL, positive urine ketone bodies and metabolic acidosis. Plain computed tomography (CT) scan revealed free gas surrounding the porta hepatis and gastric pylorus, which disappeared on the subsequent contrast-enhanced CT scan. Upper gastrointestinal endoscopy demonstrated no perforations; therefore, we assumed that the free gas was caused by spontaneous pneumoperitoneum. The patient had fulminant type 1 diabetes mellitus, as evidenced by her glycated hemoglobin A1c level of 6.9%, reduced insulin secretion and negative islet-specific autoantibodies. Pneumoperitoneum did not recur with conservative treatment, and DKA improved with intravenous fluids and insulin administration. Conservative management of DKA with spontaneous pneumoperitoneum may be considered if the patient's general condition is stable and there are no signs of peritoneal irritation.

Non-Occlusive Mesenteric Ischemia in Children With Diabetic Ketoacidosis: Case Report and Review of Literature

INTRODUCTION

Despite the use of technology, recurrent diabetic ketoacidosis (DKA) prevention remains an unmet need in children and adolescents with T1D and may be accompanied by life-threatening acute complications. We present a rare case of non-occlusive mesenteric ischemia (NOMI) with overt manifestation after DKA resolution and a discussion of recent literature addressing DKA-associated NOMI epidemiology and pathogenesis in children and adolescents.

CASE PRESENTATION

A 13-year-old female with previously diagnosed T1D, was admitted at our emergency department with hypovolemic shock, DKA, hyperosmolar state and acute kidney injury (AKI). Mildly progressive abdominal pain persisted after DKA correction and after repeated ultrasound evaluations ultimately suspect for intestinal perforation, an intraoperative diagnosis of NOMI was made.

CONCLUSION

The diagnosis of DKA-associated NOMI must be suspected in pediatric patients with DKA, persistent abdominal pain, and severe dehydration even after DKA resolution.

Nonocclusive mesenteric ischemia associated with a hyperosmolar hyperglycemic state: Hepatic portal venous gas as an indicator of mesenteric ischemia

Background

The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. Herein, we aimed to report a case of NOMI associated with a hyperosmolar hyperglycemic state (HHS). A small amount of hepatic portal venous gas (HPVG) triggered the diagnosis of NOMI.

Case Presentation

A 77‐year‐old man was transferred due to shock and disorder of consciousness. He was diagnosed with an HHS. We suspected intestinal ischemia due to a small amount of HPVG revealed by computed tomography (CT). Peritoneal signs were revealed after treatment for the HHS. Computed tomography was carried out again 5 h after admission, which showed a large amount of HPVG, remarkable bowel dilatation, and pneumatosis intestinalis. We performed an emergency laparotomy and resected the small bowel necrosis resulting from NOMI.

Conclusion

An HHS can cause NOMI, and the presence of HPVG on CT is an important finding that suggests mesenteric ischemia, even in small amounts.