Case Study on Mesenteric Vein Thrombosis

Researchers at Robert Wood Johnson University Hospital Somerset, Somerville, NJ have noted an interesting report that highlighted that the mesenteric vein thrombosis should be considered in the diagnostic algorithm while treating patients in the setting of a hyperosmolar hyperglycemic syndrome or diabetic ketoacidosis.

The case study is published in the American Journal of Health-System Pharmacy.

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two extremes in the spectrum of decompensated diabetes. DKA and HHS remain important causes of morbidity and mortality among diabetic patients despite well-developed diagnostic criteria and treatment protocols. However, previous studies have mentioned that although hyperglycemic crises can lead to a hypercoagulable state, there are a few instances of associated mesenteric venous thrombosis (MVT) as we scan literature.

Andrew Tsai and associates studied a case of a 44-year-old Hispanic male who arrived at the emergency department with chief complaints of lethargy, polydipsia, and polyuria. The patient had a previous medical history of type 2 diabetes, epilepsy, obesity, tobacco smoking, and was found to be noncompliant with his medications. On arrival, the patient had a serum glucose concentration of >1,600 mg/dL, and hence, hyperosmolar hyperglycemic syndrome (HHS) was diagnosed.

Thereafter, the patient was admitted to the intensive care unit with respiratory failure and subsequently developed shock refractory to fluid resuscitation, necessitating vasopressor support. Shock that is refractory to aggressive fluid resuscitation, necessitating pressor support, in the setting of HHS or diabetic ketoacidosis should prompt investigation for the underlying source of shock. Other etiologies, including hypovolemic, cardiogenic, and obstructive shock, should be considered; however, infection is the leading trigger of hyperglycemic crises.

Following the fourth day of hospital admission of the patient, a computerized tomogram was obtained for investigation of increasing abdominal tenderness which revealed superior MVT and pneumatosis intestinalis.

The result of this led to the loss of the patient on the 41st day due to recurrent pneumonia complicated by acute respiratory distress syndrome and septic shock in spite of an emergency laparotomy and enterectomy.

Therefore, based on the case study, the authors concluded that "Although rarely reported, MVT should be considered in the diagnostic algorithm in the absence of an identified infectious sources. The prompt investigation should include the use of diagnostic modalities such as computed tomography to assess for MVT."

For further details log on to: American Journal of Health-System Pharmacy, zxaa353