Masked irreversible acute ishemia of the hand: Case report

• Main Authors: Davidović Vladimir, Veselinov Vladimir
• Format: Article
• Language: English
• Published: Serbian Medical Society, Department of Emergency Medicine, Belgrade 2015-01-01
• Series: ABC: časopis urgentne medicine
• Subjects: acute ischemia; diabetic neuropathy; opioid analgesics; amputation
• Online Access: https://scindeks-clanci.ceon.rs/data/pdf/1451-1053/2015/1451-10531503008D.pdf
• ISSN: 1451-1053; 2560-3922

INTRODUCTION: Acute ischemia is a pathological condition that involves a sudden interruption of arterial blood flow in a specific region, caused by an occlusion of the blood vessel with a thrombus or embolus. After the diagnosis of acute ischemia, it is necessary to determine its stage, because it determines the thod of the treatment. AIM: To describe a patient with asymptomatic, progressed, acute, irreversible ischemia of the hand, masked with opioid analgesics and diabetic neuropathy. CASE REPORT: A 72-year-old man, presented to our hospital (department of surgery) with acute, irreversible ischemia of the right hand. Doppler-sonography verified brachial artery thrombosis. The patient had diabetic neuropathy and was operated 7 months ago due to pancreatic head adenocarcinoma. Cephalic duodenopancreatectomy by Whipple and the gastrointestinal reconstruction by Roux was performed, and then the patient was treated with chemotherapy (5- fluorouracil/leucovorin). At admission the patient was on transdermal fentanyl 100 mcg/ h and oral morphine 30 mg/ 6h for cancer pain. After a short preoperative preparation, the patient was operated in general endotracheal anesthesia, and an amputation of the right upper arm was performed, with the treatment of thrombosed brachial artery and other neurovascular elements. The patient was treated postoperatively with parenteral anticoagulation therapy and was discharged from hospital 8 days after the surgical procedure. CONCLUSION: The acute, irreversible limb ischemia (third stage by Rutherford) is treated with an emergency amputation because of vital indications. Postponement of this procedure may cause acute renal failure with rapid deterioration of general condition of the patient and the occurrence of fatal outcome.