HCA Florida Westside Hospital
acute mesenteric ischemia, atrial fibrillation, small bowel resection
Digestive System Diseases | Medicine and Health Sciences | Surgery
Acute mesenteric ischemia (AMI) in the setting of atrial fibrillation is a life-threatening abdominal emergency that requires immediate localization and clinical intervention to restore mesenteric perfusion for the prevention of developing bowel necrosis. As bowel ischemia rapidly progresses, serum metabolic derangements become prominent, guiding practitioners on effective therapeutic options. Ultimately, mesenteric ischemia progressively bolsters the possibility of a patient developing multiple organ dysfunction. Due to this minacious pathogenesis, rapid time to diagnosis can become the difference between life and death. Intraoperatively, emergent surgical intervention regarding bowel resection needs to be thoroughly reviewed and planned based on the patient's medical history and overall prognosis. Excessive bowel resection can consequently lead to the development of short bowel syndrome, a complex life-altering disease that manifests as chronic nutritional deficiency, steatorrhea, and failure to thrive.
We present a case of a 74-year-old African American female with a past medical history significant for atrial fibrillation (managed with the generic drug Rivaroxaban). The patient was transferred to Westside hospital from Baptist Urgent Care with complaints of acute abdominal pain. An abdominal computed tomography (CT) scan revealed a closedloop obstruction, prompting emergent surgical intervention after administration of K-centra as a Rivaroxaban reversal agent. Intraoperatively, 210cm of small bowel was resected due to observed irreversible ischemic changes. Mesenteric thrombosis with resultant large-segment small bowel resection was established to be the postoperative diagnosis.
This case emphasizes the importance of considering mesenteric thrombosis as a potential etiology in patients presenting with severe abdominal pain and a history of atrial fibrillation. Prompt recognition and intervention, including surgical resection, in conjunction with appropriate blood product replacement and antifibrinolytic therapy, can significantly contribute to favorable patient outcomes. Further studies are warranted to explore optimal management strategies and long-term prognosis in similar cases.
Edalati, Armand; Behaeddin, Bita C.; Aguilar, Raul; and Hai, Shaikh, "Massive Small Bowel Resection in a 74-year-old Patient with Atrial Fibrillation-Induced Mesenteric Ischemia" (2023). East Florida Research Day 2023. 9.