Small bowel ischaemia-a rare complication of diabetic ketoacidosis: a case report

Small bowel ischaemia, though rare in diabetic ketoacidosis, is a life-threatening condition marked by severe abdominal pain disproportionate to physical findings, potentially progressing to peritonitis and shock if untreated. A 54-year-old male with type 1 diabetes and alcohol dependence presented to the emergency department with persistent abdominal and back pain. He had severe metabolic acidosis, hyperglycaemia, and an elevated anion gap, consistent with diabetic ketoacidosis. A computed tomography scan showed thickening and decreased enhancement of the distal small bowel and ascending colon walls, indicating small bowel ischaemia. Treatment involved restoring blood supply to the ischaemic bowel and surgical resection of necrotic tissue. The patient stabilized postsurgery and was weaned from vasopressors and extubated 2 days later. Renal replacement therapy ceased after 8 days, and he eventually returned to normal life. This case emphasizes the importance of investigating persistent severe abdominal pain in patients with diabetic ketoacidosis to identify critical underlying conditions.