Acute mesenteric ischemia complicated by short bowel syndrome: a rare case report from Syria

BACKGROUND: Acute mesenteric ischemia (AMI) is a life-threatening pathological condition characterized by obstruction of blood flow to the intestine, it is rare and usually presents with non-specific gastrointestinal symptoms. Embolic, thrombotic and non-obstructive pathology are the main causes of this disease. Treatment varies from case to case depending on clinical and imaging findings. Open surgery is often required in advanced cases. CASE PRESENTATION: A 79-year-old female presented with sudden-onset severe generalized abdominal pain associated with nausea, vomiting, and poor oral intake. Her medical history included atrial fibrillation, valvular heart disease, diabetes mellitus, and prior coronary artery bypass surgery. Physical examination revealed abdominal pain disproportionate to clinical findings. Contrast-enhanced CT-scan findings were highly suggestive of extensive acute mesenteric ischemia. Exploratory laparotomy confirmed widespread necrosis of the small intestine, extending from approximately 40-50 cm distal to the ligament of Treitz to the ileocecal junction. Extensive bowel resection was performed, followed by creation of a double-barrel jejunoileostomy. Postoperatively, the patient developed short bowel syndrome (SBS) and remained clinically stable with dependence on total parenteral nutrition (TPN). CONCLUSION: This report emphasizes the importance of consulting emergency physicians in such cases, as their awareness of mesenteric ischemia, their appropriate diagnosis, and prompt management play a crucial role in increasing survival rates and achieving faster recovery in patients. CLINICAL TRIAL NUMBER: Not applicable.