Arfan Sara, Anbazhagan Lavanyah, Tiesenga Frederick
General Surgery, Windsor University School of Medicine, Chicago, USA.
General Surgery, West Suburban Medical Center, Chicago, USA.
Cureus. 2023 Jun 13;15(6):e40359. doi: 10.7759/cureus.40359. eCollection 2023 Jun.
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate despite surgical interventions. Morbidity and mortality are especially high in those with risk factors, which include diabetes mellitus (DM), hypertension (HTN), coronary artery disease, recent myocardial infarction, and rheumatic autoimmune diseases, among others. We present the case of a 70-year-old Caucasian woman diagnosed with AMI. The patient presented acutely to the emergency department after nine episodes of vomiting and was admitted to the surgical floor the same day for an emergent exploratory laparotomy. She presented acutely with an atypical presentation and without any progressive symptoms, despite various comorbidities. This patient was classified as "very high risk", but she had not been on any medications or monitored for any of her comorbidities. We highlight the essential and multifaceted role of family medicine physicians, also known as primary care physicians (PCPs), in the prevention of bowel ischemia and recommend the use of routine outpatient monitoring with clinical examination, blood testing, and imaging. These, along with a high index of suspicion, have clinical utility in preventing hospitalization, surgical intervention (bowel resection), and other serious sequelae of AMI. Timely detection, management, and specialist referrals from a family medicine physician can lower the overall burden on healthcare resources and personnel.
急性肠系膜缺血（AMI）是一种危及生命的疾病，尽管进行了手术干预，死亡率仍然很高。在有危险因素的患者中，发病率和死亡率尤其高，这些危险因素包括糖尿病（DM）、高血压（HTN）、冠状动脉疾病、近期心肌梗死和风湿性自身免疫性疾病等。我们报告一例70岁白人女性诊断为AMI的病例。该患者在出现9次呕吐后紧急前往急诊科，当天因紧急剖腹探查术入住外科病房。尽管有多种合并症，但她以非典型表现急性就诊，且无任何进行性症状。该患者被归类为“极高风险”，但她未服用任何药物，也未对任何合并症进行监测。我们强调家庭医学医生，也称为初级保健医生（PCP），在预防肠道缺血方面的重要且多方面的作用，并建议通过临床检查、血液检测和影像学检查进行常规门诊监测。这些措施，连同高度的怀疑指数，在预防住院、手术干预（肠切除）和AMI的其他严重后遗症方面具有临床实用性。家庭医学医生的及时检测、管理和专科转诊可以减轻医疗资源和人员的总体负担。
