ABSTRACT
Nonocclusive mesenteric ischemia (NOMI) after cardiac surgery is a rare and fatal complication. Although there are a few reports of successful treatment of NOMI, progress after treatment is not known. This case report describes the postoperative course of a 79-year-old male patient who underwent successful treatment of NOMI after aortic valve replacement (AVR). Plain abdominal computed tomography revealed gas in the small intestinal wall 14 days after AVR. Emergency massive small bowel resection was performed because wide and discontinuous necrotic changes of the small intestine were confirmed. Although the patient temporarily returned to normal life after discharge, sepsis due to urinary tract infection or acute cholecystitis and central venous route infection occurred repeatedly. The patient was intermittently admitted for a total of 14 of 25 months after the first discharge. The patient died of sepsis due to <i>Candida </i>infection and liver failure 52 months after AVR. Even if treatment for NOMI is successful, there is an unfavorable prognosis in terms of immunity and nutrition for short bowel syndrome. Because there are no symptoms or laboratory data specific to NOMI, it is considered important to immediately and adequately diagnose and treat NOMI without overlooking abnormalities after cardiac surgery.
ABSTRACT
We present a surgical case of mycotic aneurysm of the ulnar artery occurring 2 months after surgical treatment for infective endocarditis (IE). A 59-year-old man was referred to our hospital because of dyspnea and fever. An echocardiogram showed severe mitral regurgitation with vegetations. Blood culture disclosed <i>Methicillin-resistant Coagulase Negative Staphylococcus</i> (MRCNS), and brain computed tomography (CT) demonstrated an intracranial hemorrhage in the right posterior lobe. After one month of antibiotic treatment, mitral valve replacement (MVR) was performed successfully. Antibiotic treatment was continued postoperatively for 4 weeks; the C-reactive protein (CRP) level and peripheral white blood cell count were reduced to the normal range. Two months after MVR, a pulsatile mass rapidly increasing in size was seen in his right forearm. Contrast-enhanced CT showed aneurysm formation in his right ulnar artery. The aneurysm was managed by excision, and the brachial artery was reconstructed with a reversed saphenous vein graft. It is essential when observing the course of IE patients to bear in mind at all times that a healed mycotic aneurysm might increase in size.