Acute mesenteric ischemia caused by adhesive-band-induced mesenteric artery compression with secondary ileal volvulus and internal hernia: a rare case report.

INTRODUCTION: Acute mesenteric ischemia (AMI) is a surgical emergency caused by inadequate blood flow through the mesenteric vessels, resulting in intestinal ischemia and eventual gangrene of the bowel wall. The condition may result from arterial thrombosis, embolism, mesenteric venous thrombosis, or non-occlusive systemic hypoperfusion.

CASE PRESENTATION: We report a rare case of AMI in a 73-year-old female with a significant past surgical history of transabdominal hysterectomy with bilateral salpingo-oopherectomy. She presented with sudden, severe abdominal pain that was disproportionate to the relatively benign examination; she was unresponsive to multiple analgesics, raising suspicion of an underlying surgical pathology. Computed tomography angiography (CTA) showed ileal-like volvulus with vascular compromise, and features of internal hernia, prompting emergent surgery, which confirmed adhesive-band-induced mesenteric compression with the other findings. At first glance, the surgeon gave a chance to bowel; a second-look operation after 48 hours insisted on the inevitable need for resecting the involved segment of bowel.

DISCUSSION: Patients with AMI typically present with sudden-onset abdominal pain that is disproportionate to the physical examination findings (soft abdomen with mild or absent tenderness on palpation). Laboratory investigations may support the diagnosis but lack sufficient sensitivity and specificity for definitive diagnosis. CTA is the imaging modality of choice for establishing the diagnosis.

CONCLUSION: This case highlights a rare mechanism of AMI. It emphasizes the importance of taking a good history and doing a good examination, and highlights the importance of early diagnosis and management of critical surgical conditions such as AMI.