Hybrid surgery in a young patient with mesenteric thrombosis induced by psychoactive substances (clinical observation)

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Abstract

The article presents a clinical case of patient S. 36 years old with a diagnosis of acute occlusive PAS-induced (psychostimulants) mesenteric ischemia, thrombosis of the superior mesenteric artery, subtotal necrosis of the small intestine, widespread diffuse serous fibrinous peritonitis.

Patient S. underwent hybrid surgery – angiography of the celiac trunk, endovascular thromboextraction from the superior mesenteric artery, diagnostic laparoscopy, laparotomy, small intestine resection, sanitation, drainage of the abdominal cavity. After 34 hours, the patient underwent programmed relaparotomy ("second look"), revision of the abdominal organs, resection of a section of the small intestine with necrotic changes, the formation of an enteroenteroanastomosis "side-to-side", sanitation, drainage of the abdominal cavity. In the early postoperative period, the patient developed the following complications: intoxication syndrome, sepsis, water-electrolyte disorders, hypoalbuminemia, anemia of moderate severity, suppuration of a laparotomy wound. During therapy all postoperative disorders regressed. The length of hospital stay was 18 days.

The use of hybrid surgical access allowed to operate with a reduction in the volume of the resected intestine, giveв the possibility of creating an anastomosis and discharge the patient.

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About the authors

M. M. Rogal

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Author for correspondence.
Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1327-6973
SPIN-code: 4591-3844

Candidate of Medical Sciences

Russian Federation, Moscow

P. A. Yartsev

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1270-5414
SPIN-code: 4044-9661

Professor, MD

Russian Federation, Moscow

N. A. Stinskaya

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0001-8319-7440
SPIN-code: 6087-8380
Russian Federation, Moscow

A. A. Spassky

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1823-0982
SPIN-code: 7898-1643
Russian Federation, Moscow

R. V. Elokhovsky

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0009-0005-5974-9846
Russian Federation, Moscow

Y. K. Sadzaya

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0009-0002-6774-9967
Russian Federation, Moscow

N. V. Shavrina

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0002-3766-4674
SPIN-code: 2800-3548

Candidate of Medical Sciences

Russian Federation, Moscow

References

  1. ООН. Глобальные вопросы повестки дня. Борьба с наркотиками [United Nations. Global issues. Drugs (in Russ.)]. URL: https://www.un.org/ru/global-issues/drugs
  2. Drug Use by Country 2025. URL: https://worldpopulationreview.com/country-rankings/drug-use-by-country
  3. Alcoholism by Country 2025. URL: https://worldpopulationreview.com/country-rankings/alcoholism-by-country
  4. Aouini F., Bouhaffa A., Baazaoui J. et al. Acute mesenteric ischemia: study of predictive factors of mortality. Tunis Med. 2012; 90 (7): 533–6 (in French).
  5. Hakimian D., Tomer O., Hiller N. et al. Fatal Mesenteric Ischemia Induced by Synthetic Cannabinoids: A Case Report and Literature Review. Case Rep Emerg Med. 2017; 2017: 6964078. doi: 10.1155/2017/6964078
  6. Béliard A., Verreth L., Grandjean P. Oral contraceptive and acute intestinal ischemia with mesenteric venous thrombosis: a case report. Open Access J Contracept. 2017; 8: 9–11. doi: 10.2147/OAJC.S124625
  7. Bala M., Kashuk J., Moore E.E. et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017; 12: 38. doi: 10.1186/s13017-017-0150-5
  8. Gnanapandithan K., Feuerstadt P. Review Article: Mesenteric Ischemia. Curr Gastroenterol Rep. 2020; 22 (4): 17. doi: 10.1007/s11894-020-0754-x
  9. Shaheen K.? Alraies M.C., Marwany H. et al. Illicit drug, ischemic bowel. Am J Med. 2011; 124 (8):7 08–10. doi: 10.1016/j.amjmed.2011.03.003
  10. Lee J.H., Noh G.T., Lee R.A. Extensive bowel ischemia with heavy alcohol consumption: report of a case. J Korean Soc Coloproctol. 2012; 28 (1): 61–5. doi: 10.3393/jksc.2012.28.1.61
  11. Liu Y., Gu S., Gou M. et al. Alcohol consumption may be a risk factor for cerebrovascular stenosis in acute ischemic stroke and transient ischemic attack. BMC Neurol. 2024; 24 (1): 135. doi: 10.1186/s12883-024-03627-x
  12. Маревичев М.М. Развитие атеросклероза у мужчин в зависимости от употребления алкоголя. Судебная медицина. 2016; 2 (2): 81–2 [Marevichev M.M. Razvitie ateroskleroza u muzhchin v zavisimosti ot upotrebleniya alkogolya. Sudebnaya meditsina. 2016; 2 (2): 81–2 (in Russ.)].
  13. Ballard H.S. The hematological complications of alcoholism. Alcohol Health Res World. 1997; 21 (1): 42–52.
  14. Horie Y., Ishii H. Effect of alcohol on organ microcirculation: its relation to hepatic, pancreatic and gastrointestinal diseases due to alcohol. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2001; 36 (5): 471–85.
  15. Всемирный доклад о наркотиках, 2022 год. Организация Объединенных Наций, 2022 [World Drug Report 2022. United Nations, 2022 (in Russ.)] URL: https://www.unodc.org/res/wdr2022/MS/WDR22_Booklet_1_russian.pdf
  16. Daldegan-Bueno D., Maia L.O., Glass M. et al. Co-exposure of cocaine and cannabinoids and its association with select biological, behavioural and health outcomes: A systematic scoping review of multi-disciplinary studies. Eur Neuropsychopharmacol. 2021; 51: 106–31. doi: 10.1016/j.euroneuro.2021.06.002
  17. Grottesi A., Bianchi L., Ranieri F.M. et al. Unusual segmental ischemia of the small bowel from cocaine abuse. J Surg Case Rep. 2021; 2021 (4): rjab074. doi: 10.1093/jscr/rjab074
  18. Gupta A., Chang J., Shah M. Cocaine induced gastric ischemia. Int J Radiol Radiat Ther. 2018; 5 (1): 20–1. doi: 10.15406/ijrrt. 2018.05.00125
  19. Bathobakae L., Ozgur S.S., Bashir R. et al. Cocaine Gut: A Rare Case of Cocaine-Induced Esophageal, Gastric, and Small Bowel Necrosis. J Investig Med High Impact Case Rep. 2024; 12: 23247096241242569. doi: 10.1177/23247096241242569
  20. Jerrard D.A. "Designer drugs” – a current perspective. J Emerg Med. 1990; 8 (6): 733–41. doi: 10.1016/0736-4679(90)90288-7
  21. Alzu’bi A., Almahasneh F., Khasawneh R. et al. The synthetic cannabinoids menace: a review of health risks and toxicity. Eur J Med Res. 2024; 29 (1): 49. doi: 10.1186/s40001-023-01443-6
  22. Zawilska J.B., Wojcieszak J. Spice/K2 drugs – more than innocent substitutes for marijuana. Int J Neuropsychopharmacol. 2014; 17 (3): 509–25. doi: 10.1017/S1461145713001247
  23. Luethi D., Liechti M.E. Correction to: Designer drugs: mechanism of action and adverse effects. Arch Toxicol. 2022; 96 (5): 1489. doi: 10.1007/s00204-022-03244-y
  24. Анцыборов А.В., Асадуллин А.Р. Психоактивные эффекты и токсические реакции, связанные с употреблением мефедрона и метилона (обзор литературы). Интерактивная наука. 2017; 9 (19): 24–31 [Antsyborov A.V., Asadullin A.R. Psychoactive effects and toxic reactions associated with the use of mephedrone and methylone (review). Interactive Science. 2017; 9 (19): 24–31 (in Russ.)]. doi: 10.21661/r-463419
  25. Weaver M.F., Hopper J.A., Gunderson E.W. Designer drugs 2015: assessment and management. Addict Sci Clin Pract. 2015; 10 (1): 8. doi: 10.1186/s13722-015-0024-7
  26. Dirkx C.A., Gerscovich E.O. Sonographic findings in methamphetamine-induced ischemic colitis. J Clin Ultrasound. 1998; 26 (9): 479–82. doi: 10.1002/(sici)1097-0096(199811/12)26:9<479::aid-jcu9>3.0.co;2-k
  27. Holubar S.D., Hassinger J.P., Dozois E.J. et al. Methamphetamine colitis: a rare case of ischemic colitis in a young patient. Arch Surg. 2009; 144 (8): 780–2. doi: 10.1001/archsurg.2009.139
  28. Green P.A., Battersby C.L.F., Heath R.M. et al. A fatal case of amphetamine induced ischaemic colitis. Ann R Coll Surg Engl. 2017; 99 (7): e200–e201. doi: 10.1308/rcsann.2016.0350
  29. Ciupilan E., Gapp M., Stelzl R., et al. Amphetamine-induced small bowel ischemia – A case report. Radiol Case Rep. 2020; 15 (11): 2183–7. doi: 10.1016/j.radcr.2020.08.033
  30. Acosta S. Mesenteric ischemia. Curr Opin Crit Care. 2015; 21 (2): 171–8. doi: 10.1097/MCC.0000000000000189
  31. Панкратов А.А., Переходов С.Н., Сницарь А.В. и др. Эндоваскулярные методики в лечении острой мезентериальной ишемии: первый опыт. Эндоскопическая хирургия. 2021; 27 (5): 5–11 [Pankratov A.A., Perehodov S.N., Sniczar’ A.V. et al. Endovascular procedures in the treatment of acute mesenteric ischemia: the first experience. Endoskopicheskaya khirurgiya. 2021; 27 (5): 5–11 (in Russ.)]. doi: 10.17116/endoskop2021270515
  32. Миронков А.Б., Прямиков А.Д., Раутбарт С.А. и др. Результаты эндоваскулярных операций и критерии отбора к ним при острой мезентериальной ишемии. Хирургия. Журнал им. Н.И. Пирогова. 2025; 2: 13–9 [Mironkov A.B., Pryamikov A.D., Rautbart S.A. et al. Endovascular treatment and selection criteria for acute mesenteric ischemia. Pirogov Russian Journal of Surgery. 2025; 2: 13–9 (in Russ.)]. doi: 10.17116/hirurgia202502113
  33. Хрипун А.И., Миронков А.Б., Прямиков А.Д. и др. Эндоваскулярная хирургия острого артериального нарушения мезентериального кровообращения: подходы к лечению. Хирургия. Журнал им. Н.И. Пирогова. 2020; 3: 61–6 [Khripun A.I.,
  34. Mironkov A.B., Priamikov A.D. et al. Endovascular surgery for acute mesenteric ischemia. Pirogov Russian Journal of Surgery. 2020; 3: 61–6 (in Russ.)]. doi: 10.17116/hirurgia202003166
  35. Хрипун А.И., Прямиков А.Д., Миронков А.Б. и др. Острая артериальная мезентериальная ишемия – 15-летний опыт хирургического лечения в многопрофильном стационаре. Хирургия. Журнал им. Н.И. Пирогова. 2023; 6: 6–12 [Khripun A.I., Pryamikov A.D., Mironkov A.B. et al. Acute mesenteric ischemia – a 15-year experience of surgical treatment in a multi-field hospital. Pirogov Russian Journal of Surgery. 2023; 6: 6–12 (in Russ.)]. doi: 10.17116/hirurgia20230616
  36. Завражнов А.А., Соловьев И.А., Оглоблин А.Л. и др. Стратегия диагностики и лечения пациентов с острым нарушением мезентериального кровообращения в условиях многопрофильного стационара. Вестник Национального медико-хирургического Центра им. Н.И. Пирогова. 2023; 18 (2): 36–40 [Zavrazhnov A.A., Soloviev I.A., Ogloblin A.L., et al. A strategy for the diagnosis and treatment of patients with acute mesenteric circulatory disorders in a multidisciplinary hospital. Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2023; 18 (2): 36–40 (in Russ.)]. doi: 10.25881/20728255_2023_18_2_36
  37. Gries J.J., Sakamoto T., Chen B. et al. Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review. J Clin Med. 2024; 13 (5): 1217. doi: 10.3390/jcm13051217
  38. Smyth L., Bendinelli C., Lee N. et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg. 2022; 17 (1): 13. doi: 10.1186/s13017-022-00418-y
  39. Атаян А.А., Косенков А.Н., Кузнецов М.Р. и др. Гибридная тактика в лечении острого нарушения мезентериального кровообращения. РМЖ. 2019; 27 (8-II): 83–8 [Atayan A.A., Kosenkov A.N., Kuznetsov M.R. et al. Hybrid treatment tactics in acute mesenteric ishemia. RMJ. 2019; 27 (8-II): 83–8 (in Russ.)].

Supplementary files

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2. Fig. 1. 3D-CT reconstruction of abdomen with intravenous contrast: thrombosis of the superior mesenteric artery

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3. Fig. 2. Angiography of the celiac trunk: filling defect (indicated by arrow), an extended thrombus in the superior mesenteric artery

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4. Fig. 3. Necrotic loops of the small intestine

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5. Fig. 4. Proximal (a) and distal (б) edges of small intestine resection

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