2015, Number 1-2
Acute mesenteric ischaemia secondary to catastrophic antiphospholipid syndrome (CAPS): A case report
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ABSTRACTIntroduction: The catastrophic antiphospholipid syndrome (CAPS) is characterized by disseminated intravascular thrombosis with multiple organ ischemia, this is a variant of antiphospholipid antibodies syndrome (APAS), the prevalence of this disease has not yet been registered because of the scarse documented cases. Case report: Women 16 years old with a history of cocaine use, come up for abdominal pain 12 hours after onset, sudden; nausea and vomiting, difficulty breathing, unquantified hematochezia, Glasgow 8; with mean blood pressure of 50, heart rate of 120, is passed to exploratory laparotomy finding the entire colon to the rectosigmoid junction and 30 cm distal ileum ischemic without evidence of intestinal perforation. Ischemic segment resection is performed with terminal ileostomy, Hartmann closure and placement of Bogota bag for laparotomy reassessment. He is cataloged with APAS for presenting antinuclear antibodies, anticardiolipin antibodies and B2 positive glycoprotein, as well as kidney failure, deterioration of neurological status, acute liver failure, thrombosis in the resected specimen and positive antiphospholipid antibodies, meeting the criteria for the diagnosis of CAPS. Discussion: There is very little information about the association of mesenteric ischemia finding SAFC presentation in systematic reviews in PubMed and Medline, no articles were about the association of SAFC and cocaine were found; moreover, there are no data on the percentage of patients with SAFC beginning with acute mesenteric ischemia, where the surgeon diagnoses doubt whether ischemia continue or does not know the primary cause of it, there must be a "second look", for the possibility of a new neoisquemia and bowel resection. Conclusion: The acute mesenteric ischemia secondary to SAFC represents an extremely rare condition with high mortality and therefore, requires a timely surgical treatment and high diagnostic presumption to improve survival; you should always keep in mind in young patients with scarse or no predisposing risk factors.
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