Hypermagnesaemia causing mesenteric ischaemia and small bowel infarction

2021 ◽  
Vol 14 (6) ◽  
pp. e241928
Author(s):  
Grant Hubbard ◽  
Robert Nerad ◽  
Lynn Wojtasik
Keyword(s):  
Small Bowel ◽  
Muscle Relaxation ◽  
Small Bowel Resection ◽  
Distinct Pattern ◽  
Smooth Muscle Relaxation ◽  
Pathophysiological Mechanism ◽  
Mesenteric Ischaemia ◽  
Bowel Infarction ◽  
Operative Exploration ◽  
Antimesenteric Border

We present a case of mesenteric ischaemia caused by hypermagnesaemia after ingestion of a large oral dose of magnesium citrate, which resulted in smooth muscle relaxation, hypotension and bowel infarction. The patient had a history of chronic bowel dysmotility and renal impairment. On operative exploration, the bowel was noted to have a distinct pattern of ischaemia along its antimesenteric border. Small bowel resection was performed, and the patient was left in discontinuity, with definitive repair and anastomosis performed 24 hours later. The patient’s magnesium level was 8.39 mg/dL, which was treated with intermittent haemodialysis and eventually normalised over several sessions. Our patient recovered and was discharged after a month-long hospitalisation. She returned shortly after with respiratory failure and died. On review of the literature, we identified similar cases and present a pathophysiological mechanism of hypermagnesaemia causing mesenteric ischaemia, consistent between our cases and those already reported.

Cocaine-induced mesenteric ischaemia requiring small bowel resection

2021 ◽  
Vol 14 (1) ◽  
pp. e238593
Author(s):  
Asya Veloso Costa ◽  
Asiya Zhunus ◽  
Rehana Hafeez ◽  
Arsh Gupta
Keyword(s):  
Small Bowel ◽  
Social History ◽  
Bowel Resection ◽  
Early Recognition ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Mesenteric Ischaemia ◽  
Bowel Ischaemia ◽  
Systemic Complications ◽  
Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

scholarly journals Adult intussusception associated with mesenteric Meckel’s diverticulum and antimesenteric ileal polyp

2019 ◽  
Vol 12 (9) ◽  
pp. e230612
Author(s):  
Adrian K McGrath ◽  
Fatimah Suliman ◽  
Noel Thin ◽  
Ashish Rohatgi
Keyword(s):  
Small Bowel ◽  
Primary Anastomosis ◽  
Meckel’S Diverticulum ◽  
Small Bowel Resection ◽  
Meckel's Diverticulum ◽  
Adult Intussusception ◽  
Histopathological Analysis ◽  
Lead Point ◽  
Benign Polyp ◽  
Antimesenteric Border

Meckel’s diverticulum is the most common congenital abnormality affecting the gastrointestinal tract, affecting 4% of the general population. It is classically located on the antimesenteric border of the ileum within 100 cm of the ileocaecal valve. Complications may include haemorrhage, bowel obstruction, diverticulitis, perforation and malignancy. This report explores the case of intussusception in an adult, in association with a mesenteric Meckel’s diverticulum and adjacent benign polyp. A 40-year-old man presented with acute abdominal pain, affecting the central abdomen and both flanks. CT imaging revealed small bowel intussusception, with either a Meckel’s diverticulum or polyp acting as a lead point. Intraoperatively, the intussusception had already resolved; however, an inflamed outpouching was identified on the mesenteric border of the ileum, with a firm mass palpable within the bowel lumen. A 70 mm small bowel resection and primary anastomosis were performed. Histopathological analysis confirmed an inflamed Meckel’s diverticulum as well as an adjacent diverticulum comprising a benign polyp.

Massive Small Bowel Resection During Pregnancy Causing Short Bowel Syndrome

2011 ◽  
Vol 77 (12) ◽  
pp. 1589-1592 ◽  
Author(s):  
Elena Boland ◽  
Jon S. Thompson ◽  
Wendy J. Grant ◽  
Jean Botha ◽  
Alan N. Langnas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Bowel Infarction ◽  
Short Bowel ◽  
Vascular Insufficiency ◽  
Massive Small Bowel Resection

Massive small bowel infarction in pregnancy is rare but has devastating complications. Diagnosis is difficult because pregnancy masks the symptoms. Our aim was to assess risk factors and outcomes of massive resection associated with pregnancy. We conducted a review of nine patients with short bowel syndrome (SBS) secondary to massive bowel resection during pregnancy. The most common cause of bowel resection was midgut volvulus in seven patients. Four of these also had malrotation. Three others had previous abdominal operations, including gastric bypass. The two remaining patients had vascular insufficiency. Five of the nine patients presented after a cesarean delivery. There were three fetal deaths. Resulting small bowel length was less than 60 cm in all but one patient. All patients required parenteral nutrition (PN). Seven patients developed significant complications related to SBS and long-term PN. Four patients underwent transplantation. Massive small bowel resection during pregnancy is a devastating complication, which requires a high degree of suspicion to diagnose. Most patients have risk factors, which include previous surgery, congenital malrotation, and a hypercoagulable state. Surviving patients usually need long-term PN or transplantation.

scholarly journals Laparoscopic Management of Strangulated Broad Ligament Hernia

2018 ◽  
Vol 3 (3) ◽  
pp. 104-106
Author(s):  
Tanvi Khetan ◽  
Abdulzahra Hussain ◽  
Ihsan Al-Shoek ◽  
Shamsi EL-Hasani
Keyword(s):  
Small Bowel ◽  
Broad Ligament ◽  
Lower Abdominal Pain ◽  
Small Bowel Resection ◽  
Uneventful Recovery ◽  
Significant Past Medical History ◽  
Lower Quadrant ◽  
Bowel Infarction ◽  
Laparoscopic Management ◽  
The Right

Introduction: Broad ligament hernia was first reported post-autopsy by Quain in 1861. In a 1995 review article, only 61 cases had ever been reported. This paper presents a case report of broad ligament hernia and explores the literature surrounding this topic. Case Presentation: The patient presented with no significant past medical history, acute lower abdominal pain (several hours), nausea, and vomiting. Clinical examination showed a heart rate of 85 beats per minute; normal temperature, blood pressure, and respiratory rate; and a mildly distended abdomen with tenderness across the right lower quadrant. A plain abdominal X-ray showed dilated small bowel loops, and a blood test showed leukocytosis. Urgent diagnostic laparoscopy showed a broad ligament strangulated hernia with small bowel infarction. Reduction of the small bowel, resection, and side-side anastomosis were performed. The patient had an uneventful recovery, and follow up reported no postoperative complications. Conclusion: Laparoscopic management of small bowel obstruction due to broad ligament internal hernia is a safe and effective option.

Management of acute extensive portal vein thrombosis: the complexity and morbidity

2020 ◽  
Vol 13 (6) ◽  
pp. e234282 ◽  
Author(s):  
Andy Ze Lin Chen ◽  
Matthew George Roy Allaway ◽  
Rafid Al-Asady ◽  
Arthur Richardson
Keyword(s):  
Small Bowel ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Small Bowel Resection ◽  
Bowel Ischaemia ◽  
Bowel Infarction ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Intrahepatic Portosystemic Shunt ◽  
Small Bowel Infarction

A 62-year-old patient was admitted with an acute unprovoked portal vein thrombosis with splenic and mesenteric extension. His progress was complicated by progressive small bowel ischaemia and increasing clot burden despite systemic anticoagulation. This case report describes the use of catheter-directed thrombolysis via a transjugular intrahepatic portosystemic shunt, with the disease and its treatment complicated by a ruptured iatrogenic pseudoaneurysm, abdominal compartment syndrome and small bowel infarction necessitating extensive small bowel resection.

Relation of Small Bowel Resection to Nutrition in Man

1960 ◽  
Vol 38 (4) ◽  
pp. 605-615 ◽  
Author(s):  
M.H. Kalser ◽  
J.L.A. Roth ◽  
H. Tumen ◽  
T.A. Johnson
Keyword(s):  
Small Bowel ◽  
Bowel Resection ◽  
Small Bowel Resection

Soluble Guanylate Cyclase Stimulators and Activators: Where are We and Where to Go?

2019 ◽  
Vol 19 (18) ◽  
pp. 1544-1557 ◽  
Author(s):  
Sijia Xiao ◽  
Qianbin Li ◽  
Liqing Hu ◽  
Zutao Yu ◽  
Jie Yang ◽  
...  
Keyword(s):  
Guanylate Cyclase ◽  
Soluble Guanylate Cyclase ◽  
Muscle Relaxation ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Smooth Muscle Relaxation ◽  
Secondary Messenger ◽  
Physiological Processes ◽  
Cgmp Pathway ◽  
Preclinical And Clinical Studies

Soluble Guanylate Cyclase (sGC) is the intracellular receptor of Nitric Oxide (NO). The activation of sGC results in the conversion of Guanosine Triphosphate (GTP) to the secondary messenger cyclic Guanosine Monophosphate (cGMP). cGMP modulates a series of downstream cascades through activating a variety of effectors, such as Phosphodiesterase (PDE), Protein Kinase G (PKG) and Cyclic Nucleotide-Gated Ion Channels (CNG). NO-sGC-cGMP pathway plays significant roles in various physiological processes, including platelet aggregation, smooth muscle relaxation and neurotransmitter delivery. With the approval of an sGC stimulator Riociguat for the treatment of Pulmonary Arterial Hypertension (PAH), the enthusiasm in the discovery of sGC modulators continues for broad clinical applications. Notably, through activating the NO-sGC-cGMP pathway, sGC stimulator and activator potentiate for the treatment of various diseases, such as PAH, Heart Failure (HF), Diabetic Nephropathy (DN), Systemic Sclerosis (SS), fibrosis as well as other diseases including Sickle Cell Disease (SCD) and Central Nervous System (CNS) disease. Here, we review the preclinical and clinical studies of sGC stimulator and activator in recent years and prospect for the development of sGC modulators in the near future.

scholarly journals A.122 Vascular effects of propofol: smooth muscle relaxation in human isolated veins and arteries

1996 ◽  
Vol 76 ◽  
pp. 38-39
Author(s):  
Eric Le Pelley ◽  
Pierre Corbi ◽  
Thierry Chataigneau ◽  
Robert Tricoche ◽  
Jacques Fusciardi
Keyword(s):  
Smooth Muscle ◽  
Muscle Relaxation ◽  
Smooth Muscle Relaxation ◽  
Vascular Effects

scholarly journals The effect of pre-resection obesity on post-resection body composition after 75% small bowel resection in rats

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Neesha S. Patel ◽  
Ujwal R. Yanala ◽  
Shruthishree Aravind ◽  
Roger D. Reidelberger ◽  
Jon S. Thompson ◽  
...  
Keyword(s):  
Body Weight ◽  
Small Bowel ◽  
Lean Mass ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
High Fat ◽  
Low Fat ◽  
Low Fat Diet ◽  
Massive Resection ◽  
Obese Rats

AbstractIn patients with short bowel syndrome, an elevated pre-resection Body Mass Index may be protective of post-resection body composition. We hypothesized that rats with diet-induced obesity would lose less lean body mass after undergoing massive small bowel resection compared to non-obese rats. Rats (CD IGS; age = 2 mo; N = 80) were randomly assigned to either a high-fat (obese rats) or a low-fat diet (non-obese rats), and fed ad lib for six months. Each diet group then was randomized to either underwent a 75% distal small bowel resection (massive resection) or small bowel transection with re-anastomosis (sham resection). All rats then were fed ad lib with an intermediate-fat diet (25% of total calories) for two months. Body weight and quantitative magnetic resonance-determined body composition were monitored. Preoperative body weight was 884 ± 95 versus 741 ± 75 g, and preoperative percent body fat was 35.8 ± 3.9 versus 24.9 ± 4.6%; high-fat vs. low fat diet, respectively (p < 0.0001); preoperative diet type had no effect on lean mass. Regarding total body weight, massive resection produced an 18% versus 5% decrease in high-fat versus low-fat rats respectively, while sham resection produced a 2% decrease vs. a 7% increase, respectively (p < 0.0001, preoperative vs. necropsy data). Sham resection had no effect on lean mass; after massive resection, both high-fat and low-fat rats lost lean mass, but these changes were not different between the latter two rat groups. The high-fat diet and low-fat diet induced obesity and marginal obesity, respectively. The massive resection produced greater weight loss in high-fat rats compared to low-fat rats. The type of dietary preconditioning had no effect on lean mass loss after massive resection. A protective effect of pre-existing obesity on lean mass after massive intestinal resection was not demonstrated.

scholarly journals Intestinal intussusception and progressive anemia due to pyogenic granuloma of the ileum: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kodai Nagakari ◽  
Akikazu Yago ◽  
Yu Ohkura ◽  
Daisuke Tomita ◽  
Shusuke Haruta ◽  
...  
Keyword(s):  
Small Bowel ◽  
English Literature ◽  
Laboratory Data ◽  
Pyogenic Granuloma ◽  
Vascular Tumor ◽  
Small Bowel Resection ◽  
Intestinal Intussusception ◽  
Enhanced Computed Tomography ◽  
Laparoscopic Assisted ◽  
Progressive Anemia

Abstract Background Pyogenic granuloma is a benign vascular tumor, usually occurring on the skin or in the oral cavity. Small intestinal pyogenic granuloma is extremely rare, but intestinal intussusception due to the tumor is even rarer. Only 3 cases have been reported in the English literature at this writing. Case presentation An 86-year-old woman presented with abdominal pain and vomiting. Laboratory data discovered anemia. Contrast-enhanced computed tomography revealed small bowel obstruction due to intestinal intussusception. After decompression by long tube for 1 week, the obstruction did not improve and the anemia got worse. Therefore, laparoscopic assisted small bowel resection was performed as a diagnostic therapy. Pathology confirmed the diagnosis of pyogenic granuloma. The postoperative course was uneventful and the patient was discharged 10 days after surgery. Conclusions We experienced a case of intestinal intussusception and progressive anemia due to pyogenic granuloma of the ileum. Although the condition is extremely rare, surgeons must take into consideration the tumor in similar cases, and complete surgical resection is required.

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