Acute Mesenteric Ischemia in the Setting of Severe Hypertension: A Case Report

Abstract

Acute mesenteric ischaemia (AMI) is an uncommon, potentially life-threatening cause of acute abdominal pain, and early diagnosis may be difficult because clinical findings and biomarkers are non-specific. This case report describes the clinical presentation, investigations, surgical management and short-term outcome of a 55-year-old man with obesity and longstanding poorly controlled hypertension. He presented to the emergency department after 12 hours of severe abdominal pain, progressive abdominal distension and vomiting. At admission, his blood pressure was 200/140 mmHg, heart rate was 110 beats per minute and body mass index was 38.7 kg/m². Laboratory findings included leucocytosis and a serum lactate level of 3.0 mmol/L. Abdominal ultrasonography demonstrated markedly dilated bowel loops without peristalsis and prominent valvulae conniventes. Clinical evaluation suggested acute intestinal obstruction with possible mesenteric ischaemia. Intravenous labetalol was used to manage blood pressure, and emergency exploratory laparotomy identified a segment of small bowel with haemorrhagic infarction. The affected segment was resected, followed by primary end-to-end anastomosis. Histopathological examination confirmed haemorrhagic infarction. Postoperative complications included sepsis and acute kidney injury, necessitating intensive care, intravenous fluids, antibiotics and vasopressor support. The patient improved and was discharged after two weeks. This case illustrates the diagnostic and management challenges of suspected AMI in a patient presenting with severe hypertension, particularly in the setting of limited resources.