Acute mesenteric ischaemia: A case of expedited diagnosis and management using point-of-care ultrasound

Abstract

IntroductionThe term acute abdomen refers to a clinical syndrome of sudden onset, severe abdominal pain. The differential diagnosis for this presentation is broad, but most cases require emergent medical or surgical management. Especially in cases of ischaemic bowel, time to diagnosis can mean the difference between survival and death. As a result, mortality remains high in resource-limited settings.Case reportWe describe the case of a 28-year-old male who presented to an urban Ethiopian emergency centre with three days of vomiting, bloody diarrhoea, and abdominal pain. He collapsed in triage with weak pulses and an undetectable blood pressure. Point-of-care ultrasound revealed a hyperechoic, mobile mass in the left ventricle of the heart. Small bowel dilation and thickening was visualised throughout the abdomen. Mesenteric ischaemia was rapidly identified as the working diagnosis, prompting early surgical consultation and aggressive, goal-directed resuscitation.DiscussionShort of elucidating a definitive diagnosis, ultrasound narrowed the focus of an undifferentiated presentation and supported mobilisation for exploratory laparotomy. Ultimately, this circumvented several hours of time which is conventionally required to obtain computed tomography at this institution. As demonstrated in this case, point-of-care ultrasound can be life-saving in resource-limited settings where acquisition time for definitive imaging is often prohibitive.

Accuracy of FAST (Focused Abdominal Sonography in Trauma) scan in diagnosis of significant abdominal trauma using CT abdomen as gold standard.

“…Soundappan SV 18 in his research work found the diagnostic precision and clinical effectiveness of the surgeon-performed FAST among pediatric patients of BAT. 19 Two other research works concluded that FAST performed by surgeon for blunt abdominal trauma was a secure and precise with high rate of specificity. 20,21…”

Features of Choice of Operative Tactics for Acute I Ntestinal Obstruction and Diffused Peritonitis

“…По можливості слід розглянути первинний анастомоз. У випадку створення стоми лише життєздатність стоми може ввести в оману, оскільки деякі віддалені ділянки можуть бути вражені тим самим патологічним процесом [24] Висновки Після резекції тонкої кишки у випадку несудинної етіології, перевагу варто надати міжкишковому анастомозу або Y-подібному анастомозу за Майдлем.…”