Key result
Emergency laparotomy and partial small bowel resection under dual antiplatelet therapy and low-molecular-weight heparin successfully treated an ileal perforation 3 days post-stent implantation.
Why the study?
Few recommendations exist regarding treatment strategies for patients who have undergone percutaneous coronary intervention but suddenly require emergent noncardiac surgery for an unrelated reason.
Case Report (n=1)
This case demonstrates a successful management strategy for performing emergency noncardiac surgery shortly after DES implantation by maintaining dual antiplatelet therapy and low-molecular-weight heparin.
During the past century, the incidence of myocardial infarction has markedly increased worldwide. Percutaneous coronary intervention with stent implantation is often considered as the first-choice treatment, especially in emergency cases. Current guidelines recommend delayed elective noncardiac surgery for such vulnerable patients. However, few suggestions are available regarding the exact treatment strategy for patients who have already undergone percutaneous coronary intervention but suddenly need emergent noncardiac surgery for an unrelated reason. We herein present a case involving a patient with acute myocardial infarction who had undergone implantation of a drug-eluting stent and developed an ileal perforation due to fish bone ingestion 3 days postoperatively. After carefully balancing the risks of stent thrombosis and uncontrollable bleeding, dual antiplatelet therapy and low-molecular-weight heparin were given with close monitoring. Emergency laparotomy and partial small bowel resection surgery were then performed, after which the patient eventually recovered. This case indicates a possible management strategy for patients with acute myocardial infarction complicated by emergency noncardiac surgery.
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Zhao et al. (2019) conducted a case report in Acute myocardial infarction complicated by ileal perforation (n=1). Dual antiplatelet therapy, low-molecular-weight heparin, and emergency laparotomy with partial small bowel resection was evaluated on Recovery. Emergency laparotomy and partial small bowel resection under dual antiplatelet therapy and low-molecular-weight heparin successfully treated an ileal perforation 3 days post-stent implantation.
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