TAILIEUCHUNG - Ting and Dehdary International Journal of Emergency Medicine 2011, 4:20

Ting and Dehdary International Journal of Emergency Medicine 2011, 4:20 CASE REPORT Open Access Acute severe non-traumatic muscle injury following reperfusion surgery for acute aortic occlusion: case report Joseph Y Ting* and Arash Dehdary Abstract Acute aortic occlusion is a rare but catastrophic disease with a high mortality rate. Severe perioperative complications could result from revascularization of infarcted muscles. Muscle cell ischaemia and massive volume cell death lead to the release of myoglobin, potassium, and lactic acid, which could be fatal if not recognised or treated early. We highlight the life-threatening adverse effects resulting from bulk tissue infarction from nontraumatic causes such as aortic. | Ting and Dehdary International Journal of Emergency Medicine 2011 4 20 http content 4 1 20 o International Journal of Emergency Medicine a SpringerOpen Journal CASE REPORT Open Access Acute severe non-traumatic muscle injury following reperfusion surgery for acute aortic occlusion case report Joseph Y Ting and Arash Dehdary Abstract Acute aortic occlusion is a rare but catastrophic disease with a high mortality rate. Severe perioperative complications could result from revascularization of infarcted muscles. Muscle cell ischaemia and massive volume cell death lead to the release of myoglobin potassium and lactic acid which could be fatal if not recognised or treated early. We highlight the life-threatening adverse effects resulting from bulk tissue infarction from non-traumatic causes such as aortic occlusion followed by the metabolic sequelae of reperfusion. This is similar to the pathophysiology of traumatic crush injuries and rhabdomyolysis. The case highlights the vigorous pre-emptive treatment of acidosis and hyperkalaemia required during surgical revascularisation to potentially avert adverse surgical outcomes in acute aortic obstruction. Background Acute aortic occlusion is a rarely encountered but frequently fatal emergency resulting from de novo thrombus formation subjacent to atherosclerotic aortic mucosal lining or the peripheral embolisation of dislodged centrally located thrombus to obstruct a previously healthy aorta. We describe the de novo hyperacute development of totally occlusive extensive infrarenal aortic thrombus that progressed to bilateral limb-threatening ischaemia that on surgical reperfusion led to a metabolic surge acidaemia hyperkalaemia that eventuated in irreversible cardiac arrest. The case highlights the need to anticipate early and pre-emptively treat life-threatening toxic metabolic surge from acute compartment release and reperfusion of non-traumatic bulk tissue infarction a risk well recognised in rhabdomyolysis .

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