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Concealed mesenteric ischemia after total knee arthroplasty: A case report
Sheng-Yang Zhang1, Bang-Jian He2, Hui-Hui Xu3
1Department of Orthopedics, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing 312000, Zhejiang Province, China.
World Journal of Clinical Cases
|August 26, 2021
Summary
Mesenteric ischemia (MI) is a rare complication after knee arthroplasty, often presenting without typical gastrointestinal symptoms. Early recognition and awareness are crucial for orthopedic surgeons to manage this life-threatening condition.
Area of Science:
- Critical care medicine
- Gastroenterology
- Orthopedic surgery
Background:
- Mesenteric ischemia (MI) is a severe condition in critical care, often associated with major surgery.
- This case highlights a rare instance of concealed MI following knee arthroplasty.
Observation:
- A patient developed persistent fever and elevated infection markers post-knee arthroplasty, initially treated as periprosthetic infection.
- Delayed onset of gastrointestinal symptoms, altered consciousness, and shock led to a diagnosis of mesenteric ischemia with necrosis.
Findings:
- The patient was diagnosed with ascending colonic mesenteric ischemia and necrosis 54 days after surgery.
- Surgical intervention, specifically a right hemicolectomy, resulted in patient improvement.
Implications:
- Concealed mesenteric ischemia can be easily misdiagnosed, especially when gastrointestinal symptoms are absent.
- Orthopedic surgeons must maintain a high index of suspicion for MI in patients with unexplained post-operative complications.
