Non-occlusive Mesenteric Ischemia as a Fatal Complication in Acute Pancreatitis: A Case Series.

BACKGROUND: Vascular complications of severe acute pancreatitis are well known and largely described unlike non-occlusive mesenteric ischemia, which is a rare and potentially fatal complication. Non-occlusive mesenteric ischemia is an acute mesenteric ischemia without thrombotic occlusion of blood vessels, poorly described as a complication of acute pancreatitis. METHODS: We retrospectively reviewed a prospectively maintained registry of all pancreatic diseases referred to our center from 2013 to 2018, in order to determine the causes of early death. We identified three patients who died within 48 h after hospital admission from severe acute pancreatitis complicated by irreversible non-occlusive mesenteric ischemia. Their clinical presentation, management, and outcomes were herein reported. RESULTS: Three consecutive patients with severe acute pancreatitis developed non-occlusive mesenteric ischemia within the first 5 days after onset of symptoms and died 48 h after non-occlusive mesenteric ischemia diagnosis despite optimal intensive care management and surgery, giving a prevalence of 3/609 (0.5%). Symptoms were unspecific with consequently potential delayed diagnosis and management. High doses of norepinephrine required for hemodynamic support (n = 3) potentially leading to splanchnic vessels vasoconstriction, transient hypotension (n = 3), and previous severe ischemic cardiomyopathy (n = 1) could be involved as precipitating factors of non-occlusive mesenteric ischemia. CONCLUSION: Non-occlusive mesenteric ischemia can be a fatal complication of acute pancreatitis but is also challenging to diagnose. Priority is to reestablish a splanchno-mesenteric perfusion flow. Surgery should be offered in case of treatment failure or deterioration but is still under debate in early stage, to interrupt the vicious circle of intestinal hypoperfusion and ischemia.

Intrathoracic hooked wire migration managed by minimally invasive thoracoscopic surgery.

Background: Needle-guided localization wire is widely used to locate non-palpable breast lesion before surgery. A rare complication of this technique is wire migration. We report a case of an intrathoracic hooked wire migration in a 41-year-old female treated by video-assisted thoracoscopic surgery (VATS).Methods: We report a recent patient history and we review the cases reported in the literature.Results: Hook removal by thoracoscopy seemed to be the less invasive and most effective approach for this stable case. Even asymptomatic migration should be treated, and the device removed. The less invasive approach can be considered after estimating the risk and best possible timing.Conclusion: The loss of a hooked wire can lead to dramatic lesions. In every case, the device must be found or, if not, migration ruled out. The hooked wire must be removed, and the timing and the approach must be adapted to each case. VATS should be considered, in a stable patient to assess the lesions, to treat them and to remove the device.