Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2024; 12(18): 3567-3574
Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3567
Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report
Xian-Ping Lin, Xin-Li Guo, He-Feng Tian, Zheng-Rong Wu, Wei-Jie Yang, Hong-Ying Pan
Xian-Ping Lin, Xin-Li Guo, He-Feng Tian, Hong-Ying Pan, Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
Zheng-Rong Wu, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
Wei-Jie Yang, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
Author contributions: Lin XP designed the study and drafted the manuscript; Guo XL and Tian HF were responsible for the collection and analysis of the experimental data; Wu ZR, Yang WJ and Pan HY revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Supported by The Health Science and Technology Program of Zhejiang Province, No. 2022KY836.
Informed consent statement: Informed consent has been obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Ying Pan, MM, Doctor, Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Shangcheng District, Hangzhou 310020, Zhejiang Province, China. panhy5202023@163.com
Received: February 28, 2024
Revised: April 13, 2024
Accepted: May 6, 2024
Published online: June 26, 2024
Processing time: 111 Days and 6.9 Hours
Abstract
BACKGROUND

Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.

CASE SUMMARY

A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection.

CONCLUSION

After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.

Keywords: Superior mesenteric artery; Hemorrhagic shock; Arterial ligation; Emergency nursing; Case report

Core Tip: Case report of a 55-year-old male man with extremely unstable vital signs and was unconscious with a laceration on his head, a heart rate of 143 beats/min, shallow and fast breathing caused by trauma, diagnosed with superior mesenteric artery rupture, abdominal hemorrhage, hemorrhagic shock, and scalp laceration. After admission, he was successfully rescued by multidisciplinary team.