Small Intestine Necrosis Presented as acute Abdomen in Elderly Diabetic Type 2 Patient.

Abstract

Background: Bowel infarction or gangrenous bowel represents an irreversible injury to the intestine resulting from insufficient blood flow. It is considered a medical emergency because it can quickly result in life-treating infection and death. Untreated bowel infarction quickly leads to life-threatening infection and sepsis and may be fatal. The only treatment for bowel infarction is immediate surgical repair and removal of the dead bowel segment. CT scan can help in the diagnosis, but CT angiography is most accurate in its ability to define the lesion. Diabetes mellitus is metabolic disease which presented with lack of insulin secretion (type 1 DM) or defect of insulin effect on tissues (type 2 DM) and both conditions lead to excess sugar in blood. DM can lead to serious medical conditions, which seen often in emergency department presented as acute complications diabetic ketoacidosis/hyperglycemic hyperosmolar condition (DKA/HHC) or acute conditions based on chronic complications. Uncontrolled diabetes mellitus especially in elderly patients with many years on antidiabetic therapy and other comorbidities can cause serious life treating illness and lead to death. Case report: We present case of small intestine necrosis in 78-year-old women with hetero anamnesis for one-week abdominal pain and altered consciousness. The patient is many years diabetic with oral antidiabetic therapy and last four years with Insulin. She was diagnosed with acute abdomen condition and DKA/HHC. Initial glycemic values on admission were measured 38.87mmol/l. CT scan was made. She received emergency treatment for the current hyperglycemic disorder and after stabilization of primary condition she was transfer to operating room where laparotomy was performed. Resection of gangrenous small intestine was made and then continued postoperative care in ICU. Conclusion: The case illustrates two emergency conditions in one time in poor regulated DM in elderly patient and possibility of acute presentation on chronic complication of DM.

Keywords

• Small intestine necrosis
• bowel infarction
• Diabetic ketoacidosis
• Hyperglycemic hyperosmolar