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Mesenteric venous thrombosis: A lethal complication of hyperglycemic crises
Andrew Tsai1, Amanda Teichman1,2, Christopher A Butts1
1Robert Wood Johnson University Hospital Somerset, Somerville, NJ.
Summary
Hyperosmolar hyperglycemic syndrome (HHS) can rarely cause mesenteric venous thrombosis (MVT). Worsening abdominal pain in patients with HHS and shock requires urgent investigation for MVT.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Gastroenterology
Background:
- Hyperglycemic crises, such as hyperosmolar hyperglycemic syndrome (HHS), can induce a hypercoagulable state.
- Mesenteric venous thrombosis (MVT) is a rare but serious complication associated with hyperglycemic crises.
Purpose of the Study:
- To highlight the association between hyperglycemic crises and mesenteric venous thrombosis (MVT).
- To emphasize the importance of investigating MVT in patients with hyperglycemic crises and refractory shock.
Main Methods:
- Case report of a 44-year-old male with type 2 diabetes presenting with HHS.
- Utilized computed tomography (CT) scan to diagnose superior mesenteric venous thrombosis (MVT) and pneumatosis intestinalis.
- Managed the patient with fluid resuscitation, vasopressor support, emergency laparotomy, and enterectomy.
Main Results:
- The patient was diagnosed with HHS and subsequently developed shock refractory to fluid resuscitation.
- CT scan revealed superior MVT and pneumatosis intestinalis.
- Despite aggressive treatment, the patient succumbed to complications including recurrent pneumonia and septic shock.
Conclusions:
- Shock refractory to resuscitation in hyperglycemic crises warrants investigation for underlying causes, including MVT.
- While infection is a common trigger for hyperglycemic crises, MVT should be considered when no infectious source is identified.
- Prompt diagnostic imaging, such as CT scans, is crucial for identifying MVT in this clinical context.
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