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Bowel ischemia in a baby with unspecified renovascular hypertension: a case report.

Oda O, Zamakhshary M, Namshan MA, Jadaan SA, Shalaan HA - J Med Case Rep (2011)

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Surgery, Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Saudi Arabia. omaroda1968@hotmail.com.

ABSTRACT

Renovascular hypertension due to congenital multiple visceral arterial stenoses in neonates is rare. Management is challenging and has not been standardized. Medical control of blood pressure remains the first-line therapeutic approach. However, unwise control of blood pressure in such cases may lead to disastrous situations.

We present the case of an 18-day-old Saudi girl with hypertension due to unspecified vascular occlusive disease. The hypertension was managed medically by maintaining blood pressure at 'near normal' levels, and this led to bowel ischemia. Our patient survived the short bowel syndrome and is now two years old. She is on full oral feeding and has reached acceptable growth parameters. Her blood pressure has stabilized at around 110/70 mmHg without anti-hypertensive drugs. She has good organ function and walks despite increased narrowing in stenotic areas and complete obliteration of her left iliac and femoral arteries as seen on follow-up computed tomography angiography.

We suggest keeping blood pressure at the highest levels permissible in similar clinical situations to prevent a state of bowel hypoperfusion. When alternative treatments for congenital multiple visceral arterial stenoses are not feasible, careful medical therapy and a waiting approach for collaterals to develop may be appropriate.

No MeSH data available.


Related in: MedlinePlus

A computed tomography angiogram shows stenosis of both renal arteries near the ostium (arrows).
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Figure 1: A computed tomography angiogram shows stenosis of both renal arteries near the ostium (arrows).

Mentions: She was admitted to the pediatric intensive care unit and required daily doses of 1.8 mg of hydralazine, 9 mg of propranolol, and 12 mg of captopril to keep her systolic BP in the range of 85 to 142 mmHg and her diastolic BP in the range of 43 to 75 mmHg. Laboratory studies showed the following: a white blood cell count of 32.8 × 109 cells/L, a hemoglobin level of 102 g/L, a platelet count of 804 × 109 cells/L, erythrocyte sedimentation rate of 2 mm/hour, normal renal and liver profile results, normal urine analysis results, a serum renin level of 625 nmol/L, a serum cortisol level of 526 nmol/L, and a growth hormone level of 58 μg/L. An echocardiogram showed severe non-obstructive hypertrophy of both ventricles and normal cardiac function. A Doppler ultrasound of her renal arteries revealed severe bilateral renal artery stenosis with a peak systolic velocity of 250 cm/second and a resistive index of 0.89. A computed tomography (CT) angiography revealed multiple arterial stenoses involving both renal arteries near the ostium (Figure 1), the superior mesenteric artery (Figure 2), the celiac artery, the hepatic artery, and both femoral arteries.


Bowel ischemia in a baby with unspecified renovascular hypertension: a case report.

Oda O, Zamakhshary M, Namshan MA, Jadaan SA, Shalaan HA - J Med Case Rep (2011)

A computed tomography angiogram shows stenosis of both renal arteries near the ostium (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3285044&req=5

Figure 1: A computed tomography angiogram shows stenosis of both renal arteries near the ostium (arrows).
Mentions: She was admitted to the pediatric intensive care unit and required daily doses of 1.8 mg of hydralazine, 9 mg of propranolol, and 12 mg of captopril to keep her systolic BP in the range of 85 to 142 mmHg and her diastolic BP in the range of 43 to 75 mmHg. Laboratory studies showed the following: a white blood cell count of 32.8 × 109 cells/L, a hemoglobin level of 102 g/L, a platelet count of 804 × 109 cells/L, erythrocyte sedimentation rate of 2 mm/hour, normal renal and liver profile results, normal urine analysis results, a serum renin level of 625 nmol/L, a serum cortisol level of 526 nmol/L, and a growth hormone level of 58 μg/L. An echocardiogram showed severe non-obstructive hypertrophy of both ventricles and normal cardiac function. A Doppler ultrasound of her renal arteries revealed severe bilateral renal artery stenosis with a peak systolic velocity of 250 cm/second and a resistive index of 0.89. A computed tomography (CT) angiography revealed multiple arterial stenoses involving both renal arteries near the ostium (Figure 1), the superior mesenteric artery (Figure 2), the celiac artery, the hepatic artery, and both femoral arteries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pediatric Surgery, Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Saudi Arabia. omaroda1968@hotmail.com.

ABSTRACT

Renovascular hypertension due to congenital multiple visceral arterial stenoses in neonates is rare. Management is challenging and has not been standardized. Medical control of blood pressure remains the first-line therapeutic approach. However, unwise control of blood pressure in such cases may lead to disastrous situations.

We present the case of an 18-day-old Saudi girl with hypertension due to unspecified vascular occlusive disease. The hypertension was managed medically by maintaining blood pressure at 'near normal' levels, and this led to bowel ischemia. Our patient survived the short bowel syndrome and is now two years old. She is on full oral feeding and has reached acceptable growth parameters. Her blood pressure has stabilized at around 110/70 mmHg without anti-hypertensive drugs. She has good organ function and walks despite increased narrowing in stenotic areas and complete obliteration of her left iliac and femoral arteries as seen on follow-up computed tomography angiography.

We suggest keeping blood pressure at the highest levels permissible in similar clinical situations to prevent a state of bowel hypoperfusion. When alternative treatments for congenital multiple visceral arterial stenoses are not feasible, careful medical therapy and a waiting approach for collaterals to develop may be appropriate.

No MeSH data available.


Related in: MedlinePlus