Ischemic Enteric Necrosis Following Cardiac Surgery With Cardiopulmonary Bypass:A Case Report And Review Of Research Progression

Objective:Even ischemic enteric necrosis following cardiac surgery with CPB has a lower morbidity,however leading to a higher mortality due to difficulty of diagnosis and treatment timely.This paper aims at discussing the causes, mechanisms, pathophysiology, clinical manifestations, auxiliary examinations and research progression of this complication through case report.Methods:A case of enteric necrosis following cardiac surgery with CPB is reviewed and further discussed according to the recent research progression associated.Design:Case report.Clinical case:Patient,female,62 years old,was hospitalized with RHD,MS and MI,TI,AI,AF and DM Ⅱ.And coronarography illustrates that the three-quarters middle left anterior descending branch of coronary artery is stenosis.Then the patient is underwent surgery of CABG,MVR and TVR under general anesthesia,hypothermia and CPB.After a few days,septic shock complicated with abdominal pain and distension occurs,then acute peritonitis is diagnosed through abdominocentesis.So emergency operation of exploratory laparotomy is operated.For the next days,the patient is often experienced disorder of circulation system,shock,infection and MODS. Then rescue associated is invalid and the patient is death.Results:Rescue is failure and the patient is death.Discussion:Intestine,as central organ of stress reaction,is not only destroyed by damage factors,but may leads to secondary damage.The occurrence regularity of ischemic enteric necrosis after cardiac surgery following CPB can be summarized as follows:intestine suffers from ischemia injury;intestinal mucosal barrier function is defective;bacteria and LPS enter into circulation system;the damage factors above stimulates multiple inflammatory mediators release out of control,then leads to SIRS;when the balance of SIRS and CARS is broken,MODS occurs,thus secondary damage arouses.According to the records of literature and information,some prevention methods such as improvement of CPB,propofol,traditional Chinese medicine, ulinastatin, ITF,tranexamic acid may relieve the injury effect of damage factors above.So these methods,to some extent,can prevent and improve the prognosis of ischemic enteric necrosis under CPB,which have some clinical values.Conclusions:Though Ischemic enteric necrosis after cardiac surgery following CPB is not common,however incidence is ambiguous, progression is rapid,mortality is high and prevention is difficult early and timely.Thus avoiding ischemia or anoxia of intestine and preventing injury of intestinal mucosal barrier should be emphasized.