A young male 30 years old healthy BMI 29 ; no comorbid condition presents with superior mesenteric ischemia- what is left is T-colon and Duodenal stump;
On laparotomy; tube duodenostomy is being done; how to manage such a case ??
Dear Ahmad.
You can get information on AMI here
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830881/pdf/68_2016_Article_634.pdf
It is unclear which type of AMI you have met in that patient. Please, pay attention to NOMI and necessity of pharmacological correction. In any case, now you have to manage full duodenal external fistula and a short bowel syndrome. If so, then: 1. TPN and 2. anastomize asap.
Sincerely Vladimir M.Khokha.
Needs at home TPN with a PICC line for now.. Lengthening or other operations etc will not work for him... He is a definite candidate for small bowel transplant.. although not available in Pakistan he needs to be referred to somewhere where it is done... He is only 30... :(
There are several facets to the management:
1. Nutrition: in the short term: TPN. For long term, refer to a center with experience with small bowel transplant.
2. Arterial perfusion management: If the celiac and inferior mesenteric artery are patent, should not need any additional revascularization procedure.
MESENTERIC ISCHEMIA IN A 30-YR OLD MALE:
PROTEIN C
PROTEIN S
ANTI-THROMBIN III
COAGULATION PROFILE
LIPID PROFILE/ PCV / TRBC
PATIENT IS TOO YOUNG FOR THIS ILLNESS.
A full thrombophilia screen
Management on the lines of maintaning a line for TPN and control sepsis and electrolyte abnormalities. Small bowel transplant would be the only option in a specialized center.
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