Zhang SY, He BJ, Xu HH, Xiao MM, Zhang JJ, Tong PJ, Mao Q. Concealed mesenteric ischemia after total knee arthroplasty: A case report. World J Clin Cases 2021; 9(22): 6515-6521 [PMID: 34435020 DOI: 10.12998/wjcc.v9.i22.6515]
Corresponding Author of This Article
Qiang Mao, MD, Attending Doctor, Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. zyydxmq@126.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Sheng-Yang Zhang, Department of Orthopedics, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing 312000, Zhejiang Province, China
Bang-Jian He, Pei-Jian Tong, Qiang Mao, Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Hui-Hui Xu, Jing-Jing Zhang, Institute of Orthopedics and Traumatology, The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Miao-Miao Xiao, The Second People’s Hospital of Xiaoshan District, Hangzhou 311241, Zhejiang Province, China
Author contributions: Zhang SY, Xu HH, Xiao MM, and Zhang JJ collected the information, followed the patient, and wrote the paper; Tong PJ and He BJ revised the paper; Mao Q was the patient’s primary care physician; all authors read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Mao, MD, Attending Doctor, Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. zyydxmq@126.com
Received: April 1, 2021 Peer-review started: April 1, 2021 First decision: April 28, 2021 Revised: April 30, 2021 Accepted: May 7, 2021 Article in press: May 7, 2021 Published online: August 6, 2021
Abstract
BACKGROUND
In critical care medicine, mesenteric ischemia (MI) is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery. For the first time, we report a case of concealed MI with a long course after knee arthroplasty.
CASE SUMMARY
A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery. He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine, periprosthetic debridement was performed, and the spacer was replaced, but no improvement was seen. At 54 d after arthroplasty, the patient developed gastrointestinal symptoms of nausea and vomiting, abdominal distention, and subsequently, cloudiness of consciousness, and hypotensive shock. Finally, the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy, which improved after right hemicolectomy.
CONCLUSION
Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed. Orthopedic surgeons need to be aware of this complication.
Core Tip: We describe for the first time a case of concealed mesenteric ischemia (MI), a type of MI that lacks gastrointestinal signs and symptoms with fever as the only early symptom, which makes early diagnosis extremely difficult. MI often has a poor prognosis, and orthopedic surgeons must be aware of MI as a possible complication after total knee arthroplasty so that early diagnosis and intervention can be made for such concealed MI.
