Non-occlusive distal duodenal and proximal jejunal necrosis – a case report

Żyluk, Andrzej; Jagielski, Wojciech; Piotuch, Bernard

doi:10.21164/pomjlifesci.573

Cited by 2 publications

(2 citation statements)

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“…With its rich blood supply, the incidence of isolated duodenal necrosis remains an enigma. The previously-explained etiologies of duodenal ischemia include pancreatitis [ 5 , 6 ], vasculitis [ 2 ], caustic injury, trauma, Jejunal intussusception [ 1 ] or high loop obstruction [ 3 ], and perinephric abscess [ 7 ]. Nevertheless, the etiology remains unknown in some patients [ 4 , 6 ], similar to the present case.…”

Section: Discussionmentioning

confidence: 99%

“…The previously-explained etiologies of duodenal ischemia include pancreatitis [ 5 , 6 ], vasculitis [ 2 ], caustic injury, trauma, Jejunal intussusception [ 1 ] or high loop obstruction [ 3 ], and perinephric abscess [ 7 ]. Nevertheless, the etiology remains unknown in some patients [ 4 , 6 ], similar to the present case. There was no evidence of caustic injury or trauma in the history and physical examination of the patient.…”

Section: Discussionmentioning

confidence: 99%

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Isolated duodenal ischemia of unknown etiology: a case report

2021

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Background Acute abdomen is among the most common presentations observed in clinical practice. The present study describes a patient with isolated duodenal ischemia as an extremely rare etiology of acute abdomen. Case presentation A 79-year-old male with acute abdominal pain, nausea, and vomiting presented to the emergency department of our hospital. He was diagnosed with myelodysplastic syndrome 7 years ago, for which he took thalidomide and erythropoietin as the main medications. The prominent findings of the physical examination were hypotension, tachycardia, fever, mild hypoxemia, and epigastric and right upper quadrant tenderness of the abdomen. Except for mildly increased creatinine and lipase, other laboratory findings were in concordance with myelodysplastic syndrome. Due to the patient’s oliguria, the computed tomography (CT) scan was performed without contrast, which, together with the ultrasonography, raised the clinical impression of acute pancreatitis. The patient’s hypotension was refractive to supportive treatment, resulting in progressive deterioration of the clinical condition. A later contrast-enhanced CT scan suggested microvascular ischemia of the duodenum. An emergent Whipple’s procedure was planned initially, which was later switched to a damage control surgery due to the patient’s cardiac arrest during the surgery. Despite all the supportive therapy provided at the intensive care unit, the patient expired of a cardiac arrest which occurred two hours after the termination of the surgery. Conclusions The high rate of mortality in duodenal necrosis necessitates emergent diagnosis and proper management. When other common etiologies are ruled out, clinicians should consider duodenal pathology as a potential cause of acute abdomen.

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