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Ischemic Colitis Caused by Intra-Aortic Balloon Pump Counterpulsation.

El-Halawany H, Bajwa A, Shobassy M, Qureini A, Chhabra R - Case Rep Gastrointest Med (2015)

Bottom Line: However, complications including distal emboli, balloon rupture, bleeding, limb loss, and bowel ischemia continue to be associated with them.We present a case of a 56-year-old male who suffered bowel ischemia as a result of a malpositioned IABP.While the benefit of such devices in critically ill patients is not disputed, patients as well as clinicians should be aware of the potential side effects and patients undergoing IABP placement should be monitored for complications.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA ; Internal Medicine, UMKC School of Medicine, Kansas City, MO 64108, USA ; Section of Gastroenterology/Hepatology, Temple University Hospital, 3401 N. Broad Street, Philadelphia, PA 19140, USA.

ABSTRACT
Intra-aortic balloon pump counterpulsation (IABP) has been shown to prolong life in critically ill cardiac patients. However, complications including distal emboli, balloon rupture, bleeding, limb loss, and bowel ischemia continue to be associated with them. We present a case of a 56-year-old male who suffered bowel ischemia as a result of a malpositioned IABP. While the benefit of such devices in critically ill patients is not disputed, patients as well as clinicians should be aware of the potential side effects and patients undergoing IABP placement should be monitored for complications.

No MeSH data available.


Related in: MedlinePlus

Endoscopic findings of abnormal vascularity, congestion, erosions, nodularity, granularity, erythema, and ulceration of the cecum and ascending colon consistent with ischemic colitis.
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fig1: Endoscopic findings of abnormal vascularity, congestion, erosions, nodularity, granularity, erythema, and ulceration of the cecum and ascending colon consistent with ischemic colitis.

Mentions: An African American male in his 50s presented with increased shortness of breath, dyspnea on exertion, and orthopnea. He has a past medical history of coronary artery disease with multiple myocardial infarctions and two coronary stents placed in 2003 and two additional coronary stents placed two months prior to his admission. He had a history of systolic heart failure with a left ventricle ejection fraction of 20%. In the emergency department atrial fibrillation with rapid ventricular rate was noted with a heart rate of 140. A diltiazem infusion was started and he was admitted to the Cardiac Intensive Care Unit. Repeat echocardiogram several days later showed progressive worsening of his ischemic cardiomyopathy with an ejection fraction of 18%. He was started on inotropic support and underwent placement of an intra-aortic balloon pump (IABP) to assist with hemodynamic stability. Approximately 24 hours later the patient had an episode of melena associated with a drop in his hemoglobin from 10.1 to 7.7. He was started on proton pump inhibitor infusion. He underwent emergent esophagogastroduodenoscopy which showed erythema and erosions in the gastric fundus compatible with gastritis as well as grade 1 reflux esophagitis but no evidence of active bleeding. A Helicobacter pylori stool antigen was found to be negative. A colonoscopy was performed after hemodynamic stabilization for further evaluation of melena and pretransplant screen. This was positive for abnormal vascularity, congestion, nodularity, erosions, erythema, and ulceration in the cecum and ascending colon suggestive of ischemic colitis which was later confirmed by biopsy (Figure 1). Given the unusual involvement of nonwatershed areas such as the cecum and ascending colon, a CT of the abdomen and pelvis with contrast was performed to evaluate the celiac and mesenteric vasculature. There was no significant narrowing of either vessel noted on the CT; however the inferior metallic marker of the IABP was found to be inferior to the origin of the superior mesenteric artery (Figure 2). Findings were consistent with ischemic colitis of the cecum and ascending colon as visualized on colonoscopy from occlusion caused by the IABP. The IABP was repositioned and the patient's melena resolved.


Ischemic Colitis Caused by Intra-Aortic Balloon Pump Counterpulsation.

El-Halawany H, Bajwa A, Shobassy M, Qureini A, Chhabra R - Case Rep Gastrointest Med (2015)

Endoscopic findings of abnormal vascularity, congestion, erosions, nodularity, granularity, erythema, and ulceration of the cecum and ascending colon consistent with ischemic colitis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644544&req=5

fig1: Endoscopic findings of abnormal vascularity, congestion, erosions, nodularity, granularity, erythema, and ulceration of the cecum and ascending colon consistent with ischemic colitis.
Mentions: An African American male in his 50s presented with increased shortness of breath, dyspnea on exertion, and orthopnea. He has a past medical history of coronary artery disease with multiple myocardial infarctions and two coronary stents placed in 2003 and two additional coronary stents placed two months prior to his admission. He had a history of systolic heart failure with a left ventricle ejection fraction of 20%. In the emergency department atrial fibrillation with rapid ventricular rate was noted with a heart rate of 140. A diltiazem infusion was started and he was admitted to the Cardiac Intensive Care Unit. Repeat echocardiogram several days later showed progressive worsening of his ischemic cardiomyopathy with an ejection fraction of 18%. He was started on inotropic support and underwent placement of an intra-aortic balloon pump (IABP) to assist with hemodynamic stability. Approximately 24 hours later the patient had an episode of melena associated with a drop in his hemoglobin from 10.1 to 7.7. He was started on proton pump inhibitor infusion. He underwent emergent esophagogastroduodenoscopy which showed erythema and erosions in the gastric fundus compatible with gastritis as well as grade 1 reflux esophagitis but no evidence of active bleeding. A Helicobacter pylori stool antigen was found to be negative. A colonoscopy was performed after hemodynamic stabilization for further evaluation of melena and pretransplant screen. This was positive for abnormal vascularity, congestion, nodularity, erosions, erythema, and ulceration in the cecum and ascending colon suggestive of ischemic colitis which was later confirmed by biopsy (Figure 1). Given the unusual involvement of nonwatershed areas such as the cecum and ascending colon, a CT of the abdomen and pelvis with contrast was performed to evaluate the celiac and mesenteric vasculature. There was no significant narrowing of either vessel noted on the CT; however the inferior metallic marker of the IABP was found to be inferior to the origin of the superior mesenteric artery (Figure 2). Findings were consistent with ischemic colitis of the cecum and ascending colon as visualized on colonoscopy from occlusion caused by the IABP. The IABP was repositioned and the patient's melena resolved.

Bottom Line: However, complications including distal emboli, balloon rupture, bleeding, limb loss, and bowel ischemia continue to be associated with them.We present a case of a 56-year-old male who suffered bowel ischemia as a result of a malpositioned IABP.While the benefit of such devices in critically ill patients is not disputed, patients as well as clinicians should be aware of the potential side effects and patients undergoing IABP placement should be monitored for complications.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA ; Internal Medicine, UMKC School of Medicine, Kansas City, MO 64108, USA ; Section of Gastroenterology/Hepatology, Temple University Hospital, 3401 N. Broad Street, Philadelphia, PA 19140, USA.

ABSTRACT
Intra-aortic balloon pump counterpulsation (IABP) has been shown to prolong life in critically ill cardiac patients. However, complications including distal emboli, balloon rupture, bleeding, limb loss, and bowel ischemia continue to be associated with them. We present a case of a 56-year-old male who suffered bowel ischemia as a result of a malpositioned IABP. While the benefit of such devices in critically ill patients is not disputed, patients as well as clinicians should be aware of the potential side effects and patients undergoing IABP placement should be monitored for complications.

No MeSH data available.


Related in: MedlinePlus