ACUTE MESENTERIC ISCHEMIA REVEALING A SEVERE MITRAL STENOSIS: A CASE REPORT

Introduction: Rheumatic mitral stenosis remains a common valvular heart disease in Morocco, systemic thromboembolism is the principal complication especially with atrial fibrillation. Acute mesenteric ischemia (AMI) is an interruption of the blood supply to different portions of the small intestine, leading to ischemia and intestinal necrosis. It is a life?threatening condition with a mortality rate of 60?80 %. We describe a case of AMI successfully medically managed while waiting for the management of severe mitral stenosis.

Case Report: A 53-year-old patient with a history of recurrent angina was admitted to the emergency department with a surgical abdomen presenting with abdominal pain and bilious vomiting. An abdominal ultrasound was initially requested, but came back without any abnormalities , Abdominal CT angiography showed grelic ischemic wall thickening due to an occlusive thrombosis of the superior mesenteric artery . Etiological research found severe mitral stenosis without organized thrombus in the left atrium on transthoracic echocardiography.

Discussion: Acute mesenteric ischemia is a rare complication of mitral stenosis, it is an acute abdominal emergency, its incidence is low with approximately 0.14% case per year. Mortality rate is about 70%, This pathological entity can lead to intestinal necrosis and death. It is often associated with concomitant embolization in other vascular territories, including spleen or kidney.

Conclusion: Mesenteric ischemia is a fatal and rare complication of mitral stenosis. Management is often surgical or interventional, but can also be medical.