Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6515
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
Processing time: 117 Days and 11.8 Hours
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.
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.
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.