Small Intestine Necrosis Presented as acute Abdomen in Elderly Diabetic Type 2 Patient.

Abstract

Background: Bowel infarction or gangrenous bowel represents an irreversible injury to the intestine resulting from insufficient blood flow. It is considered a medical emergency because it can quickly result in life-treating infection and death. Untreated bowel infarction quickly leads to life-threatening infection and sepsis and may be fatal. The only treatment for bowel infarction is immediate surgical repair and removal of the dead bowel segment. CT scan can help in the diagnosis, but CT angiography is most accurate in its ability to define the lesion. Diabetes mellitus is a metabolic disease that presented a lack of insulin secretion (type 1 DM) or a defect of insulin effect on tissues (type 2 DM) and both conditions lead to excess sugar in the blood. DM can lead to serious medical conditions, which are seen often in emergency departments and presented as acute complications of diabetic ketoacidosis/hyperglycemic hyperosmolar condition (DKA/HHC) or acute conditions based on chronic complications. Uncontrolled diabetes mellitus especially in elderly patients with many years of antidiabetic therapy and other comorbidities can cause serious life treating illnesses and lead to death.
Case report: We present a case of small intestine necrosis in a 78-year-old woman with hetero anamnesis for one-week abdominal pain and altered consciousness. The patient is many years diabetic with oral antidiabetic therapy for the last four years with Insulin. She was diagnosed with acute abdomen condition and DKA/HHC. Initial glycemic values on admission were measured at 38.87mmol/l. CT scan was made. She received emergency treatment for the current hyperglycemic disorder and after stabilization of the primary condition she was transferred to the operating room where a laparotomy was performed. Resection of the gangrenous small intestine was made and then continued postoperative care in ICU.
Conclusion: The case illustrates two emergency conditions at one time in poorly regulated DM in elderly patients and the possibility of acute presentation on the chronic complications of DM.