Nonocclusive mesenteric ischemia following multiple wasp stings.

Area of Science:

• Toxicology
• Gastroenterology
• Emergency Medicine

Background:

• Massive wasp envenomation can lead to severe systemic reactions beyond anaphylaxis.
• Delayed toxin-mediated effects like hemolysis, coagulopathy, rhabdomyolysis, acute renal failure, and hepatotoxicity are known but rarely reported.
• Nonocclusive mesenteric ischemia is a particularly rare complication of wasp stings.

Observation:

• A 66-year-old man was stung over 30 times by wasps.
• He initially presented with pain but no anaphylaxis.
• Twenty hours post-envenomation, he developed vomiting, abdominal pain, and lower gastrointestinal bleeding.

Findings:

• The patient was diagnosed with delayed systemic reactions including mesenteric ischemia, rhabdomyolysis, acute renal failure, and hepatotoxicity.
• Contrast-enhanced computed tomography suggested nonocclusive mesenteric ischemia due to abrupt tapering of mesenteric arteries without thrombi or emboli.
• Histologic examination after emergency laparotomy confirmed nonocclusive mesenteric ischemia.

Implications:

• This case highlights a previously undocumented complication of massive wasp envenomation.
• It underscores the importance of monitoring for delayed systemic reactions after significant wasp stings.
• Clinicians should consider nonocclusive mesenteric ischemia in patients with severe wasp envenomation presenting with abdominal symptoms.