09 January 2009

Case solution and outcome

Congratulations to the twelve commenters who correctly identified the abnormal findings from the abdominal radiograph in this previous post.   It was indeed pneumatosis coli due to acute mesenteric ischemia.

I will admit that this was not a terribly difficult diagnosis for me to make since the patient began the conversation saying "That nice Dr Vascular put a stent in my IMA on Tuesday, and I was doing just fine until today when suddenly I started hurting."

I wish all my patients were as clear and direct as that.

Pneumatosis is a collection of air within the intestinal wall in very small vesicles; it is almost universally associated with necrosis of the affected area (aka dead gut).  It's a very ominous finding, as the mortality rate for mesenteric ischemia is very high.   I believe that the mortality is much worse for small intestinal ischemia, due to the larger distribution of intestine covered by the SMA. 

This case had a surprisingly happy outcome.  A stat angio showed that the stent was patent, so the patient proceeded to the OR and had an uneventful hemicolectomy and made a full recovery.   The ischemia was presumed to be from diffuse distal vascular disease which was not amenable to reconstruction.

Thanks for playing!

5 comments:

  1. Interesting case! Gives new meaning to 'gas pains'. Oh I know it was weak...but come on...

    ReplyDelete
  2. For those of us who have little medical training, can you define IMA and SMA? (My Google-fu generally sucks and fails me here.)

    ReplyDelete
  3. Sorry; SMA= Superior mesenteric artery, which supplies the blood flow to the small bowels (most of them), and the IMA= Inferior mesenteric artery, which supplies the blood flow to the large intestine.

    Cheers,
    SF

    ReplyDelete
  4. surprising indeed... my first thought was call a vascular surgeon and a priest!

    ReplyDelete
  5. Katie, you might want to get a copy of a medical abbreviations card (also free online) http://www.media4u.com/bbp/p_ma.html if you like med blogs like I do & don't have any background.

    I only hope I don't become an annoying patient... it's amazing how vast medical knowledge is, and makes it even more amazing what docs & nurses know and do.

    Sorry for the product pimp, doc; I don't get paid for this.

    Admitting my complete ignorance,
    j

    ReplyDelete