Hypothermia and the acute abdomen

Area of Science:

• Vascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• A 64-year-old male with a history of congestive heart failure, hypertension, and intermittent claudication due to abdominal aortic occlusion presented with hypothermia and confusion.
• His presentation was marked by profound hypothermia (31°C), reduced lower limb power, and absent peripheral pulses.

Observation:

• Initial laboratory findings included metabolic acidosis with hyperlactatemia, neutrophilia, and electrolyte imbalances.
• Abdominal CT scan revealed extensive thromboembolic disease in the abdominal arterial tree, diagnosing acute mesenteric ischemia.

Findings:

• Emergency laparotomy identified a perforated duodenum, which was surgically repaired.
• The patient underwent an axillofemoral bypass with femoral-femoral crossover to address the extensive thromboembolic disease.

Implications:

• This case highlights the critical interplay between profound hypothermia, mesenteric ischemia, and abdominal emergencies.
• It underscores the challenges in managing complex vascular and gastrointestinal emergencies in critically ill patients.
• The case emphasizes the need for prompt diagnosis and aggressive surgical intervention in acute mesenteric ischemia and associated complications.