Management challenges in a patient presenting with acute mesenteric ischaemia

A man in his 60s presented with severe abdominal pain, vomiting and obstipation for the last 2 days. His examination revealed a tender abdomen. The contrast-enhanced CT of the abdomen reported superior mesenteric artery thrombosis with ischaemic changes in the bowel. After initial resuscitation, an exploratory laparotomy was done, revealing a gangrenous small bowel of 323 cm, which was resected, and a double-barrel jejuno-ileostomy was performed. Postoperatively, total parenteral nutrition was started and gradually replaced with oral supplements and refeeding of bowel contents. One week after discharge, the patient presented with features of severe dehydration and short bowel syndrome. After resuscitation and stabilisation, restoration of bowel continuity was performed. The patient developed the refeeding syndrome postsurgery, which was managed with micronutrient supplementation. This case highlights the challenges of managing a patient with short bowel syndrome, including timely surgical intervention, postoperative monitoring and appropriate nutritional management for the best outcome.