Management of a Patient With Acute Abdomen and Thyroid Storm

Acute abdomen often requires urgent surgical intervention. In certain instances, thyrotoxicosis can contribute to the onset of acute abdomen. This relationship complicates both diagnosis and management. Therefore, understanding the interplay between thyrotoxicosis and acute abdomen is essential for implementing effective treatment strategies. This case report aims to illustrate the diagnostic and therapeutic challenges encountered in managing a patient with mesenteric ischemia due to thyroid storm, emphasizing the importance of a multidisciplinary approach in achieving favorable outcomes.

We describe a case of a 54-year-old female who presented with acute abdominal pain, rapidly deteriorating to respiratory failure requiring intubation. Initial investigations revealed an embolic occlusion of the superior mesenteric artery and signs of bowel ischemia as well as cardiopulmonary decompensation. To evaluate the cause of the cardiac failure, subsequent thyroid function tests confirmed hyperthyroidism. The patient underwent endovascular embolectomy, bowel resection, and later a total thyroidectomy.

The patient's acute abdomen was managed with embolectomy and bowel resection. A Burch-Wartofsky score of 75 was highly suggestive of thyroid storm, leading to an urgent total thyroidectomy after interdisciplinary discussion. Histopathological examination confirmed chronic thyroid inflammation with increased endocrine activity.

This case highlights the serious complication of mesenteric ischemia due to thyroid storm. Endovascular thrombectomy and bowel resection effectively managed the ischemia, while thyroidectomy facilitated a rapid return to a euthyroid state. This case serves as a valuable reference for the management of similar presentations, demonstrating the potential for successful outcomes with timely, aggressive treatment.