Acute Intestine Attack: Complex Surgery and Expert Care Saved a Life at Apollo Hospital Ahmedabad

Acute Intestine Attack: Complex Surgery and Expert Care Saved a Life at Apollo Hospital Ahmedabad.

A 50-year-old male presented with severe, sudden abdominal pain, vomiting, and abdominal distension for three days.

After medical evaluation, it was discovered that the patient had a blockage in the small intestine’s vein, medically referred to as Acute Superior Mesenteric Vein (SMV) thrombosis.

This condition had led to gangrene in a 40 cm section of his small intestine (jejunum), a life-threatening complication.

He underwent emergency surgery in Jodhpur, where the gangrenous portion of the intestine was removed.

However, after the surgery, complications arose, including a leak at the site where the intestine was rejoined.

Due to the complexity of the case, the patient was referred to Apollo Hospital, Ahmedabad, where he came under the care of Dr. Shravan Bohra*, Senior Gastroenterologist at Apollo Hospital Ahmedabad.

At Apollo, he required a second surgery to manage the leakage. Dr. Avinash Tank, Senior Gastro Surgeon, performed the complex procedure. The primary challenges in this surgery included operating on a patient who was on blood thinners—critical to maintaining blood flow to the intestines—and dealing with the poor condition of the remaining jejunum, which had edema and was not suitable for a new surgical joint.

Due to these complexities, Dr. Tank opted for a specialized approach, creating a new intestinal joint with the duodenum, using advanced surgical techniques. A feeding tube was also inserted into the small intestine to ensure proper nutrition while the intestine healed.

Despite the successful surgery, the patient experienced further complications, including bleeding from a raw area in the intestine seven days post-surgery. This bleeding, attributed to the necessary blood thinners, was successfully managed with a blood transfusion and close monitoring.

Dr. Shravan Bohra,  Senior Gastroenterologist at Apollo Hospital Ahmedabad, emphasizes the critical nature of early diagnosis. “Acute Mesenteric Ischaemia is a time-sensitive condition. Delays in treatment can lead to irreversible damage to the intestines, which makes it essential for patients experiencing sudden, unexplained abdominal pain to seek immediate medical attention.”

Dr. Apurva Shah, another expert in Gastroenterology at Apollo hospital, notes the complexity of managing such cases. “The management of Acute Mesenteric Ischaemia is multifaceted and requires a team approach. Surgeons, gastroenterologists, radiologists, and nutritionists all play vital roles in ensuring the best possible outcomes.”

Dr. Avinash Tank, Senior Gastro Surgeon, highlights the surgical challenges associated with the condition. “Operating on a patient with Acute Mesenteric Ischaemia, especially one on blood thinners, is always difficult. The key to successful outcomes is careful preoperative planning, skilled surgical techniques, and comprehensive post-operative care.”

 Symptoms of Acute Mesenteric Ischaemia

Acute Mesenteric Ischaemia (AMI), also referred to as an “Acute Intestine Attack,” is a condition that occurs when blood flow to the intestines is severely reduced or blocked. The most common symptoms include:

• Sudden and Severe Abdominal Pain: The pain is often out of proportion to what is seen during a physical examination and may appear very quickly.
• Nausea and Vomiting: Patients may experience persistent nausea and vomiting as the intestine struggles to function.
• Abdominal Distension:  As the intestine becomes damaged, gas and fluid may build up, causing bloating and swelling of the abdomen.
• Diarrhea or Bloody Stools: In some cases, as the intestine is deprived of blood, it can lead to the passing of blood through stools.
• Fever and Signs of Sepsis: If the intestine begins to die due to lack of blood, the patient may develop signs of infection, including fever and a rapid heart rate.

Treatment Options for Acute Mesenteric Ischaemia

The treatment of Acute Mesenteric Ischaemia depends on the severity and cause of the condition. Treatment generally involves:

• Medications:  In cases where a blood clot is involved, anticoagulants (blood thinners) may be administered to dissolve the clot and restore blood flow. These medications may also be given to prevent further clot formation.
• Surgery: If a significant portion of the intestine has become necrotic or gangrenous, surgery is required to remove the dead tissue. In severe cases like the one discussed, multiple surgeries may be needed to repair damaged areas, stop bleeding, or address complications such as leaks.
• Endovascular Procedures:  In some cases, interventional radiology techniques may be used to remove the clot or restore blood flow without the need for major surgery.
• Nutritional Support: Often, the intestines are unable to process food for some time after surgery. In such cases, a feeding tube may be inserted to deliver nutrients directly into the digestive system.
• Post-Surgical Care: This includes monitoring for infection, managing pain, ensuring proper nutrition, and regulating anticoagulant therapy to prevent further clots.

Prevention of Acute Mesenteric Ischaemia

Preventing Acute Mesenteric Ischaemia is particularly challenging, especially in individuals who have risk factors like heart disease, clotting disorders, or a history of vascular problems. Key prevention strategies include:

• Managing Underlying Conditions: Patients with heart disease, high blood pressure, diabetes, or clotting disorders should work closely with their healthcare provider to control these conditions.
• Lifestyle Modifications: Stopping smoking, maintaining a healthy diet, and engaging in regular exercise are essential steps in reducing vascular risk.
• Medications: In high-risk patients, doctors may prescribe blood thinners to reduce the likelihood of clot formation.
• Routine Check-ups: Regular monitoring, especially for individuals with known vascular conditions or clotting disorders, can help catch problems early before they lead to an emergency.

Conclusion

Acute Intestine Attack: Complex Surgery and Expert Care Saved a Life at Apollo Hospital Ahmedabad. This successful treatment showcases the incredible expertise available at Apollo Hospital, Ahmedabad, and underscores the importance of rapid diagnosis, specialized surgical techniques, and comprehensive care in managing severe intestinal conditions.