Intestinal adaptation in fluid restricted cardiac failure following extensive bowel resection.

Acute mesenteric ischemia (AMI) is an emergency associated with a high mortality rate. A high index of clinical suspicion, prompt diagnosis and treatment is necessary to improve the patient outcome. The principle of damage control surgery should be adopted in the management of critically ill surgical patients with AMI. Strategic planning by resecting the ischemic bowel, physiological restoration and planned reassessment of remnant bowel with a definitive procedure is recommended. The resection of a long segment ischemic bowel may result in morbidity such as that of short bowel syndrome. We report here a case of decompensated cardiac failure in a 56-year-old lady, presented with one-day history of severe acute epigastric pain and abdominal distension. She presented with extensive bowel ischemia involving most of the superior mesenteric artery distribution. Damage control surgery followed by entero-colic anastomosis was performed 48 hours later. The patient recovered with remarkable intestinal adaptation without exhibiting short bowel syndrome symptoms despite the postulated theory of altered intestinal permeability in decompensated cardiac failure.

Relapsing retroperitoenal abscess secondary to juvenile dermatomyositis: Complexity in management.

Juvenile dermatomyositis (JDM) is a systemic autoimmune condition with myopathy. Gastrointestinal and pulmonary manifestations are rare presentation of JDM. Gastrointestinal perforation incidence in JDM is associated with vasculopathy and ischaemia. There are only few reported case of management of JDM with gastrointestinal complication. Management of such condition is challenging. We present a 21-year-old man with spontaneous descending colon perforation undergoing Hartmann's procedure. He subsequently presented with recurrent retroperitoneal abscess at five and 30 months following the initial presentation which was treated with percutaneous drainage. A high index of suspicion is necessary in JDM patients presenting with acute abdomen.