Ding Peng, Zhou Yuan, Long Kun-Lan, Zhang Song, Gao Pei-Yang
Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China.
Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
World J Clin Cases. 2022 Oct 6;10(28):10244-10251. doi: 10.12998/wjcc.v10.i28.10244.
Percutaneous coronary intervention (PCI) is extensively used to treat acute coronary syndromes (ACS). Acute mesenteric ischemia is a life-threatening disease if untreated.
An 81-year-old female presented with 3 d of lethargy and 1 d of dyspnea. On November 16, 2021, the patient developed a coma. Her oxygen saturation dropped to 70%-80%, the patient was admitted to the intensive care unit for further treatment. Chest computed tomography (CT) showed chronic bronchitis, emphysema, and multiple lung infections. Abdominal CT scan showed no obvious abnormalities, but have severely calcified abdominal vessels. The patient received assisted ventilation, and vasoactive, and anti-infection drugs. Troponin level was elevated. Since the patient was in a coma, it could not be determined whether she had chest pain. The cardiologist assumed that the patient had developed ACS; therefore, the patient underwent PCI the left femoral artery approach, and no obvious abnormalities were found in the left and right coronary arteries. On the second postoperative day, the patient presented with abdominal distension and decreased bowel sounds; constipation was considered and a glycerin enema was administered. On day 4, the patient suddenly lost consciousness, and had decreased blood pressure, abdominal wall swelling with increased tension, and absence of bowel sounds. An urgent abdominal CT scan revealed gas in her hepatic portal system with extensive bowel wall necrosis. The patient died on day 5 due to intractable shock.
The potential serious complications in patients undergoing PCI, especially the patients who are hemodynamically unstable and have severely calcified abdominal vessels, should all be considered.
经皮冠状动脉介入治疗（PCI）被广泛用于治疗急性冠状动脉综合征（ACS）。急性肠系膜缺血若不治疗是一种危及生命的疾病。
一名81岁女性，出现3天嗜睡和1天呼吸困难。2021年11月16日，患者陷入昏迷。她的血氧饱和度降至70%-80%，被收入重症监护病房进一步治疗。胸部计算机断层扫描（CT）显示慢性支气管炎、肺气肿和多处肺部感染。腹部CT扫描未显示明显异常，但腹部血管严重钙化。患者接受了辅助通气、血管活性药物和抗感染药物治疗。肌钙蛋白水平升高。由于患者处于昏迷状态，无法确定她是否有胸痛。心脏病专家推测患者发生了ACS；因此，患者经左股动脉途径接受了PCI，左、右冠状动脉未发现明显异常。术后第二天，患者出现腹胀和肠鸣音减弱；考虑便秘并给予甘油灌肠。第4天，患者突然失去意识，血压下降，腹壁肿胀且张力增加，肠鸣音消失。紧急腹部CT扫描显示其肝门静脉系统有气体，肠壁广泛坏死。患者于第5天因顽固性休克死亡。
应考虑PCI患者，尤其是血流动力学不稳定且腹部血管严重钙化患者可能出现的严重并发症。
