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Introduction: Diagnosing non-occlusive mesenteric ischaemia (NOMI) in patients is complicated, due to poor signs and symptoms and non-specific laboratory tests, leading to a high mortality rate. This case study presents the rare case of a patient who developed mesenteric ischaemia after an emergency thoracic endovascular aneurysm repair (TEVAR) for a type B aortic dissection (TBAD) and peri-operative cardiogenic shock. Study outcomes revealed that intestinal fatty acid binding protein (I-FABP) identified early mucosal damage two days before the clinical presentation. Report: A 43 year old male patient was admitted to the emergency department with an acute TBAD and a dissection of the superior mesenteric artery (SMA), for which TEVAR was performed with additional stent placement in the SMA. Peri-operatively, the patient went into cardiogenic shock with a sustained period of hypotension. Post-operatively, the plasma I-FABP levels were measured prospectively, revealing an initial increase on post-operative day five (551.1 pg/mL), which continued beyond day six (610.3 pg/mL). On post-operative day seven, the patient developed a fever and demonstrated signs of peritonitis and bowel perforation. He underwent an emergency laparotomy, followed by an ileocaecal resection (<100 cm) with a transverse ileostomy. Pathological analysis confirmed the diagnosis of mesenteric ischaemia. Discussion: The diagnosis of NOMI in critically ill patients is often complicated, and the currently available diagnostic markers lack the specificity and sensitivity to detect early intestinal injury. This case report highlights that elevated I-FABP in plasma levels may indicate the presence of early mesenteric injury. Further research needs to be conducted before I-FABP can be applied in daily practice.
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INTRODUCTION: Metastasis of basal cell carcinoma (BCC) is a very rare finding because the disease is mostly discovered early in development and treated immediately. Moreover, the metastasis percentage is less than 0.5%. PATIENT AND METHODS: A 66-year-old man presented to the emergency department after a fall from his bike. He sustained fractures, and a 40-year-old skin lesion was discovered on his back. Histological analysis of a biopsy from the primary lesion, a CT scan, and bone biopsy were performed. RESULTS: The three tests combined confirmed BCC with metastasis to the liver, lung, and bone. We also systematically eliminated the possibility of other skin lesions, such as squamous cell carcinoma, angiosarcoma, cutaneous lymphoma, and melanoma. CONCLUSION: We report an accidental discovery of a rare case of a 40-year-old BCC with multiple distant metastases, resulting in stage IV disease.
