Mesenteric ischemia due to low cardiac output secondary to hemodialysis

An 80-year-old man with numerous vascular risk factors presented sudden-onset generalized abdominal pain during a hemodialysis session for advanced diabetic nephropathy. A CT scan (Fig. 1) found abundant portomesenteric gas, possibly secondary to mesenteric ischemia, with signs of distress in the intestinal loops of the central abdomen. We performed urgent surgery, resecting some 90 cm of the jejunum and ileum that showed signs of ischemia, which also contained a 12-cm segment of transmural necrosis. The patient progressed favorably and was discharged on the sixth postoperative day.

Figure 1