Treatment of refractory mesenteric traction syndrome without cyclooxygenase inhibitors

Mesenteric traction may be necessary for surgical exposure during colonic or aortic surgery. Traction on the mesentery releases prostacyclin, producing variable degrees of hypotension. Numerous cases of severe, life-threatening hypotension have been reported. The published literature suggests that treatment of severe hypotension from mesenteric traction with routine doses of vasoconstrictors may be ineffective, but inhibition of prostacyclin synthesis with cyclooxygenase inhibitors can successfully treat or prevent hypotension. This rationale, while highly beneficial, would place patients with allergies to cyclooxygenase inhibitors at a severe disadvantage, and would also leave no therapeutic options if intravenous cyclooxygenase inhibitors were not immediately available. We report the successful use of high-dose phenylephrine in the treatment of mesenteric traction syndrome.