INTRA-ABDOMINAL MULTI-ORGANS INFARCTION IN 73-YEARS OLD FEMALE PATIENT WITH HYPERTENSIVE CRISIS: A CASE REPORT AND REVIEW OF LITERATURE

Objective: Unexpected clinical course Background: In hypertensive crisis patients, intestinal ischemia has been reported, while gastric ischemia is rare due to its multiple blood supply. A hypertensive crisis is classified according to the progression of end-organ failure, which includes cerebral, cardiac, and renal insults. Case Presentation: A 73-year-old female patient with uncontrolled hypertension and diabetes mellitus presented with dyspnea and fatigue. Her blood pressure was 248/157 mmHg and her serum blood glucose was 301 mg/dl. In the emergency room, she received antihypertensive treatment and was admitted to the intensive care unit to be monitored. 48 hours later, she developed nausea, vomiting, constipation and severe abdominal pain. A CT scan of the abdomen revealed infarction patches in the left renal and the spleen while the first colonoscopy was irrelevant. The second colonoscopy revealed left colonic and sigmoid necrosis. Finally, she underwent exploratory laparotomy that identified ischemic necrosis of the greater curvature of the stomach, multiple levels of the small intestine, sigmoid and descending colon. Partial gastrectomy, left colonic resection, sigmoidectomy, and colostomy were done. Conclusion: This case illustrates the unusual site of ischemia in an uncontrolled hypertensive patient, as well as the difficulty of managing the patient and the adverse outcome. In order to rule out intra-abdominal organ involvement, any patient who develops abdominal pain in the course of hypertensive emergency should be evaluated for surgical consultation and contrast-enhanced CT.