背景:非心脏手术后房颤增加死亡率,住院时间,和医疗费用;此外,与非瓣膜性心房颤动相比,它带来了类似的血栓栓塞并发症的风险。在这份报告中,我们讨论了我们在意外的术后新发房颤导致急性肠系膜缺血的诊断和治疗决策过程.
方法:一名78岁男性患者接受了右腿静脉曲张剥脱结扎。患者以前是健康的,没有已知的合并症。手术后的第二天,他抱怨突然的上腹痛对保守治疗没有反应,在心电图上观察到新发房颤。
方法:腹部计算机断层扫描显示肠系膜上动脉急性栓塞性闭塞。
方法:紧急手术取栓成功。从认识到腹痛到手术的时间为6小时。对危及生命的缺血再灌注损伤进行外科重症监护。
结果:患者于术后第40天出院。
结论:对保守治疗无反应的非典型术后腹痛应视为外科急症,需要高度怀疑急性肠系膜缺血。术前心电图和术后遥测可能对一些无症状患者有所帮助。
BACKGROUND: Postoperative atrial fibrillation following noncardiac surgery increases mortality, length of hospital stay, and medical expenses; moreover, compared to nonvalvular atrial fibrillation, it poses a similar risk of thromboembolic complications. In this report, we discuss our decision-making process for diagnosis and treatment in
case with unexpected postoperative new-onset atrial fibrillation causing acute mesenteric ischemia.
METHODS: A 78-year-old male patient received varicose vein stripping and ligation in his right leg. The patient was previously healthy with no known comorbidities. The next day after surgery, he complained of sudden epigastric pain unresponsive to conservative treatment, and new-onset atrial fibrillation was observed on electrocardiography.
METHODS: An abdominal computed tomography scan revealed acute embolic occlusion of the superior mesenteric artery.
METHODS: Emergent surgical embolectomy was performed successfully. The time to operation from the recognition of abdominal pain was 6 h. Surgical critical care was performed for life-threatening ischemic reperfusion injury.
RESULTS: The patient was discharged from the hospital on the 40th postoperative day.
CONCLUSIONS: Atypical postoperative abdominal pain unresponsive to conservative treatment should be considered a surgical emergency, and a high level of clinical suspicion for acute mesenteric ischemia is required. Preoperative electrocardiography and postoperative telemetry might be helpful in some asymptomatic patients.