Reflections on the domino effect of a patient with multimorbidity: A case report and literature review.

RATIONALE: As China enters an accelerated stage of global population aging, multimorbidity has emerged as a significant public health challenge. Current management strategies often focus primarily on index diseases, neglecting the complex interplay of multiple conditions in elderly patients.

PATIENT CONCERNS: An 86-year-old female with multimorbidity, including diabetes, hypertension, and osteoporosis, sustained a femoral fracture. Following "artificial bone replacement" surgery, she experienced significant loss of consciousness with a drastic decline in hemoglobin from 110 to 39 g/L.

DIAGNOSES: The patient's femoral fracture triggered a cascade of complications, resulting in hypoglycemic coma, gastrointestinal bleeding, and acute cerebral infarction. Utilizing a multimorbidity framework, general practitioners hypothesized and subsequently confirmed nonocclusive mesenteric ischemia (NOMI) as the cause of bleeding.

INTERVENTIONS: Management included timely interventions focused on addressing the underlying NOMI, specifically volume expansion and vasodilator therapy.

OUTCOMES: Following the targeted interventions addressing both the primary conditions and complications, the patient recovered sufficiently to be discharged from the hospital.

LESSONS: This case underscores the importance of holistic approaches in clinical practice when managing elderly patients with multimorbidity. It demonstrates how multiple conditions can interact in a domino effect and highlights the value of considering less common diagnoses like NOMI in complex elderly patients with multiple comorbidities.