Reversible Acute Mesenteric Ischemia
A 60-year-old man presented with abdominal pain and hypotension. He had recently had thrombosis of the superior mesenteric artery, which required extensive resection of the distal jejunum and ileum. His serum lactate level was 2.6 mmol per liter (normal range, 0.5 to 2.2), and his creatinine level was 1.6 mg per deciliter (140 μmol per liter) as compared with a baseline level of 0.9 mg per deciliter (78 μmol per liter). A computed tomographic scan showed jejunal dilatation and thinning of the bowel wall (Panel A, arrows), which suggested the recurrence of acute mesenteric ischemia in the remnant jejunum. Endoscopic examination through the jejunostomy revealed mucosal gangrene and hemorrhage (Panel B, Video 1). Because arterial revascularization was not an option owing to extensive distal thrombosis, the patient was treated medically for presumed intestinal ischemic injury with bowel rest, intravenous fluids, heparin, aspirin, and oral antibiotics. His symptoms abated within 14 days, at which time the patient underwent repeat endoscopy, which revealed mucosal healing (Panel C, Video 2). The patient was discharged after oral refeeding, with no recurrence of symptoms.