Limits...
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.


A follow-up computed tomography angiogram shows complete obliteration of the left external iliac and femoral arteries (arrow) and development of collateral circulation (dotted arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3285044&req=5

Figure 3: A follow-up computed tomography angiogram shows complete obliteration of the left external iliac and femoral arteries (arrow) and development of collateral circulation (dotted arrows).

Mentions: At present, she is two years old and has normal cardiac, liver, and renal functions. She is on full oral feeding, and her weight is 11.5 kg. She has not required anti-hypertensive medications for the last six months. A recent CT angiography revealed increased narrowing of both renal arteries, her superior mesenteric artery, her celiac artery, and her hepatic artery and complete obliteration of her left external iliac and left femoral arteries. However, a good set of collateral vessels was seen during the evaluation (Figure 3).


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 follow-up computed tomography angiogram shows complete obliteration of the left external iliac and femoral arteries (arrow) and development of collateral circulation (dotted arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A follow-up computed tomography angiogram shows complete obliteration of the left external iliac and femoral arteries (arrow) and development of collateral circulation (dotted arrows).
Mentions: At present, she is two years old and has normal cardiac, liver, and renal functions. She is on full oral feeding, and her weight is 11.5 kg. She has not required anti-hypertensive medications for the last six months. A recent CT angiography revealed increased narrowing of both renal arteries, her superior mesenteric artery, her celiac artery, and her hepatic artery and complete obliteration of her left external iliac and left femoral arteries. However, a good set of collateral vessels was seen during the evaluation (Figure 3).

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.