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Open Access Case report

Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology

Lois Haruna, Ahmed Aber, Farhan Rashid* and Marco Barreca

Author Affiliations

Department of General Surgery, Luton and Dunstable Hospital, Lewsey Road, Luton, Bedfordshire, LU4 ODZ, UK

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BMC Surgery 2012, 12:21  doi:10.1186/1471-2482-12-21

Published: 30 October 2012

Abstract

Background

Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology.

Case presentation

We report a unique case of a 53 year old Italian lady who presented with acute mesenteric ischaemia and duodenal perforation. This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation.

Conclusion

Early management in the intensive care unit and appropriate surgical intervention maximised the patient’s chances of survival despite the poor prognosis associated with her dual pathology. The rare pathology of the patient described can be explained by two possible hypotheses: peptic ulcer disease causing duodenal ulceration, which precipitated ischaemic infarction of the small bowel. The second hypothesis is the patient developed a stress related ulcer following ischaemic bowel infarction secondary to arterial thrombosis.

Keywords:
Acute mesenteric ischaemia; Duodenal ulcer perforation; Mesenteric venous thrombosis; Ischemic bowel infarction; Bowel necrosis